chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 32.0
Sex: F
Vaccine: COVID19
Symptoms: Dizziness, Dyspnoea, Immediate post-injection reaction, Nausea, Throat tightness
Clinical narrative: Client presented vaccination site on 2/24/22. The client reported she received a 1st dose of Pfizer COVID vaccine on 2/3/22. Client is allergic to strawberries, tomatoes, and tuna. Client has a history of chronic urticaria, anxiety, and mild anemia. Client reported will start taking Iron for her anemia as of 2/24/2022. Client expressed concern since she's getting her period today and felling lightheaded as a result. Client reported immediately after receiving vaccine lightheaded upon exiting the vaccination room. Client also reported she felt difficulty breathing and her throat closing immediately after vaccination which is not normal for when she feels anxious. Client took her mask off and went outside to get fresh air. Client also reported feeling nauseous and having trembling in her hands and legs that lasted for one hour which client reports as normal when she experiences anxiety. She reported feeling really anxious the day of vaccination of her first dose of Pfizer COVID vaccine. Client reported that symptoms other than nausea resolved after 30-minute observation upon leaving vaccination site. Client did not follow up with PCP after developing symptoms.  RN encouraged client to drink from her water bottle.  RN submitted a medical consult via text message to clinical project coordinators requesting to proceed with the Pfizer COVID vaccine. Per Dr.  approval to proceed with Pfizer COVID vaccine was obtained from medical consult team via text message from  clinical project coordinator.
Age: 32.0
Sex: F
Vaccine: COVID19
Symptoms: Tremor
Clinical narrative: Client presented vaccination site on 2/24/22. The client reported she received a 1st dose of Pfizer COVID vaccine on 2/3/22. Client is allergic to strawberries, tomatoes, and tuna. Client has a history of chronic urticaria, anxiety, and mild anemia. Client reported will start taking Iron for her anemia as of 2/24/2022. Client expressed concern since she's getting her period today and felling lightheaded as a result. Client reported immediately after receiving vaccine lightheaded upon exiting the vaccination room. Client also reported she felt difficulty breathing and her throat closing immediately after vaccination which is not normal for when she feels anxious. Client took her mask off and went outside to get fresh air. Client also reported feeling nauseous and having trembling in her hands and legs that lasted for one hour which client reports as normal when she experiences anxiety. She reported feeling really anxious the day of vaccination of her first dose of Pfizer COVID vaccine. Client reported that symptoms other than nausea resolved after 30-minute observation upon leaving vaccination site. Client did not follow up with PCP after developing symptoms.  RN encouraged client to drink from her water bottle.  RN submitted a medical consult via text message to clinical project coordinators requesting to proceed with the Pfizer COVID vaccine. Per Dr.  approval to proceed with Pfizer COVID vaccine was obtained from medical consult team via text message from  clinical project coordinator.
Age: 13.0
Sex: M
Vaccine: COVID19
Symptoms: Unevaluable event
Clinical narrative: none
Age: 25.0
Sex: F
Vaccine: COVID19
Symptoms: Bone pain, Cough, Pain in extremity
Clinical narrative: SEVERE DEEP PAIN ("FEELS LIKE BONE PAIN) IN BOTH ARMS STARTING 1-2 DAYS AFTER SHOT AND MILD COUGH
Age: 26.0
Sex: F
Vaccine: COVID19
Symptoms: Back pain, Blood glucose normal, Muscle tightness, Pain in extremity, Paraesthesia
Clinical narrative: Pain, tingling, tightness in the arm and legs and back; shakiness.  Emergency personnel were notified. Paramedics assessed patient.
Age: 26.0
Sex: F
Vaccine: COVID19
Symptoms: Tremor
Clinical narrative: Pain, tingling, tightness in the arm and legs and back; shakiness.  Emergency personnel were notified. Paramedics assessed patient.
Age: 27.0
Sex: F
Vaccine: COVID19
Symptoms: Cold sweat, Erythema, Exposure during pregnancy, Influenza like illness, Nausea
Clinical narrative: Patient presented to the Pharmacy for her Moderna Booster vaccine today.  During screening, she revealed that she was 33 weeks pregnant and was allergic to nuts and shellfish.  No other allergies or medical conditions were stated.  She was asked about prior reactions to the Moderna vaccine, specifically.  She stated that she had experienced flu-like symptoms with prior doses that lasted less than 24 hours.  She was counseled that she may have flu-like symptoms with this dose, as well as soreness or redness in her arm.  She expressed understanding.  She received vaccine without incident and moved to waiting area for 15 minute observation.  During this time, her husband asked for a container to use because his wife felt nauseous.  We provided them with a plastic bowl.  She began vomiting into bowl.  A technician and I, the Pharmacist, went out to attend to the patient.  We inquired if she needed to lay down or had itching or rash.  She stated that she did not feel like it was an allergic reaction and felt fine to remain seated.  We offered to call 911 for Paramedics, but she declined.  Patient was appearing clammy, so we provided a wet, cold cloth and ice packs.  She stated that she felt better and left the facility approximately 15 minutes later.  We asked her to let us know if her condition worsened and she had to go to the Emergency Room for further treatment.
Age: 27.0
Sex: F
Vaccine: COVID19
Symptoms: Pain in extremity
Clinical narrative: Patient presented to the Pharmacy for her Moderna Booster vaccine today.  During screening, she revealed that she was 33 weeks pregnant and was allergic to nuts and shellfish.  No other allergies or medical conditions were stated.  She was asked about prior reactions to the Moderna vaccine, specifically.  She stated that she had experienced flu-like symptoms with prior doses that lasted less than 24 hours.  She was counseled that she may have flu-like symptoms with this dose, as well as soreness or redness in her arm.  She expressed understanding.  She received vaccine without incident and moved to waiting area for 15 minute observation.  During this time, her husband asked for a container to use because his wife felt nauseous.  We provided them with a plastic bowl.  She began vomiting into bowl.  A technician and I, the Pharmacist, went out to attend to the patient.  We inquired if she needed to lay down or had itching or rash.  She stated that she did not feel like it was an allergic reaction and felt fine to remain seated.  We offered to call 911 for Paramedics, but she declined.  Patient was appearing clammy, so we provided a wet, cold cloth and ice packs.  She stated that she felt better and left the facility approximately 15 minutes later.  We asked her to let us know if her condition worsened and she had to go to the Emergency Room for further treatment.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Urinary tract infection, Urine analysis
Clinical narrative: Developed a urinary track infection.
Age: 16.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Computerised tomogram thorax abnormal, Dyspnoea, Pulmonary embolism
Clinical narrative: Ended up getting COVID at the beginning of February.  Difficulty breathing and taking in deep breath sxs started 02/26/2022
Age: 24.0
Sex: F
Vaccine: COVID19
Symptoms: Dizziness, Dyspnoea, Fall, Loss of consciousness, Throat tightness
Clinical narrative: Approximately one minute or two after the injection, I began to feel light-headed. Soon after, I became unconscious, at which time I dropped items that I was holding in my hands and slumped out of my chair. I remained unconscious for a few minutes. During this time, I was informed that the pharmacist had called the EMS. I continued to feel light-headed, and I had some trouble breathing as my throat felt constricted. Then, I vomited a few minutes before the EMS arrived. The EMS checked if my vital signs had returned to normal.
Age: 24.0
Sex: F
Vaccine: COVID19
Symptoms: Vomiting
Clinical narrative: Approximately one minute or two after the injection, I began to feel light-headed. Soon after, I became unconscious, at which time I dropped items that I was holding in my hands and slumped out of my chair. I remained unconscious for a few minutes. During this time, I was informed that the pharmacist had called the EMS. I continued to feel light-headed, and I had some trouble breathing as my throat felt constricted. Then, I vomited a few minutes before the EMS arrived. The EMS checked if my vital signs had returned to normal.
Age: 23.0
Sex: F
Vaccine: COVID19
Symptoms: Limb discomfort, Peripheral swelling
Clinical narrative: Pt woke up on 02/27/2022 with uncomfortable  swollen arm
Age: 76.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Unevaluable event
Clinical narrative: patient hospitalized
Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Cardiac arrest, Death, Resuscitation
Clinical narrative: this patient got covid mild covid on Jan 3rd, was then vaccinated on Feb 9th, and then had a witnessed cardiac arrest on the bus at Feb 24th. CPR was attempted, but he was unable to be resuscitated on site or at hospital where he was pronounced.
Age: 10.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Multisystem inflammatory syndrome in children
Clinical narrative: Pt developed COVID-19 in January of 2022 and subsequently developed MISC for which she was hospitalized.
Age: 49.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Unevaluable event
Clinical narrative: patient hospitalized
Age: 65.0
Sex: M
Vaccine: PPV
Symptoms: Arthralgia, Asthenia, Discomfort, Headache, Initial insomnia
Clinical narrative: Fever 36 hours, very sore stiff left arm, bicep, Elbow, head and neck area. Overall weakness for 2+ days, sweating at night, could not get comfortable to fall asleep (no sleep 36 hours post injection). Arm and Elbow pain persists today. Headache.
Age: 65.0
Sex: M
Vaccine: PPV
Symptoms: Insomnia, Musculoskeletal stiffness, Neck pain, Night sweats, Pain in extremity
Clinical narrative: Fever 36 hours, very sore stiff left arm, bicep, Elbow, head and neck area. Overall weakness for 2+ days, sweating at night, could not get comfortable to fall asleep (no sleep 36 hours post injection). Arm and Elbow pain persists today. Headache.
Age: 65.0
Sex: M
Vaccine: PPV
Symptoms: Pyrexia
Clinical narrative: Fever 36 hours, very sore stiff left arm, bicep, Elbow, head and neck area. Overall weakness for 2+ days, sweating at night, could not get comfortable to fall asleep (no sleep 36 hours post injection). Arm and Elbow pain persists today. Headache.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Unevaluable event
Clinical narrative: patient hospitalized
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Abdominal wall haematoma, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood gases abnormal, Blood loss anaemia
Clinical narrative: Hospital Course: 64 y old female patient, severely cachectic, deconditioned with nonischemic CM, LVEF 20-25%, chronic Afib, s/p BIV ICD, Prior DVT, PEs, severe MR/TR, moderate PH, Hypothyroidism, prior Stroke, CKD stage IV, high grade renal artery stenosis, chronic hypoxia, on supplemental O2, recently admitted with hemorrhagic shock, acute blood loss anemia, large right rectus sheath Hematoma, s/p coli embolization of inferior epigastric artery on 11/14 who presented on 11/29 with progressive dyspnea, multiple loose tool and acute confusion. CT chest and abdomen revealed stable size of rectus sheath hematoma, revealed right sided pleural effusion and bibasilar air space disease. SARS COV2 screen was positive. Patient was hypotensive. Improved with IV fluids and dobutamine. She was admitted with hypovolemia, severe sepsis, viral sepsis, SARS COV2 pneumonia. Initially to mod care. She was started on antimicrobial  coverage concerning super imposed bacterial pneumonia.  Patient was transferred to ICU on 12/03 after she became less responsive with progressive hypoxia, lactic acidosis.  Patient was intubated due to progressive hypoxia, worsening hemodynamic status, not tolerating BIPAP and increases in work of breathing. Intubated with RSI first attempt. Dobutamine is decreased to 2.5 mcg/kg/min. Continue Norepinephrine. Add Vasopressin given tachyarrhythmia.  Patient continues to progressively worsen hemodynamically with increase in pressor requirements, oliguria, worsening lactic acidosis. Received multiple boluses of IV fluids. Remained on broad spectrum Abx. Patient developed refractory shock with multiorgan failure ,Progressive metabolic acidosis, renal failure, known advance heart failure with severe systolic heart failure.  On maximal dose epinephrine, Norepinephrine, dobutamine and Vasopressin.   12/07: patient remained in very critical condition. On mechanical ventilation support. ABG showed PH 7.12, Pao2 of 282, Paco2 of 24. Extremely elevated D dimer of > 90 K. Patient is not on sedation. Unresponsive. Right pupil > left. Significant lactic acidosis, significant elevation in AST/ALT. Shock Liver status. INR 3.9. progressive renal failure. Oliguric. High vasoactive support demands with Norepinephrine, epinephrine, vasopressin and dobutamine. To initiate PIRRT.  Patient remained in refractory shock with multisystem failure. Did not tolerate PIRRT due to hypotension despite of maximal vasoactive support.  She expired despite numerous CPR rounds.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Blood pH decreased, COVID-19, COVID-19 pneumonia, Cardiac failure, Computerised tomogram abdomen abnormal
Clinical narrative: Hospital Course: 64 y old female patient, severely cachectic, deconditioned with nonischemic CM, LVEF 20-25%, chronic Afib, s/p BIV ICD, Prior DVT, PEs, severe MR/TR, moderate PH, Hypothyroidism, prior Stroke, CKD stage IV, high grade renal artery stenosis, chronic hypoxia, on supplemental O2, recently admitted with hemorrhagic shock, acute blood loss anemia, large right rectus sheath Hematoma, s/p coli embolization of inferior epigastric artery on 11/14 who presented on 11/29 with progressive dyspnea, multiple loose tool and acute confusion. CT chest and abdomen revealed stable size of rectus sheath hematoma, revealed right sided pleural effusion and bibasilar air space disease. SARS COV2 screen was positive. Patient was hypotensive. Improved with IV fluids and dobutamine. She was admitted with hypovolemia, severe sepsis, viral sepsis, SARS COV2 pneumonia. Initially to mod care. She was started on antimicrobial  coverage concerning super imposed bacterial pneumonia.  Patient was transferred to ICU on 12/03 after she became less responsive with progressive hypoxia, lactic acidosis.  Patient was intubated due to progressive hypoxia, worsening hemodynamic status, not tolerating BIPAP and increases in work of breathing. Intubated with RSI first attempt. Dobutamine is decreased to 2.5 mcg/kg/min. Continue Norepinephrine. Add Vasopressin given tachyarrhythmia.  Patient continues to progressively worsen hemodynamically with increase in pressor requirements, oliguria, worsening lactic acidosis. Received multiple boluses of IV fluids. Remained on broad spectrum Abx. Patient developed refractory shock with multiorgan failure ,Progressive metabolic acidosis, renal failure, known advance heart failure with severe systolic heart failure.  On maximal dose epinephrine, Norepinephrine, dobutamine and Vasopressin.   12/07: patient remained in very critical condition. On mechanical ventilation support. ABG showed PH 7.12, Pao2 of 282, Paco2 of 24. Extremely elevated D dimer of > 90 K. Patient is not on sedation. Unresponsive. Right pupil > left. Significant lactic acidosis, significant elevation in AST/ALT. Shock Liver status. INR 3.9. progressive renal failure. Oliguric. High vasoactive support demands with Norepinephrine, epinephrine, vasopressin and dobutamine. To initiate PIRRT.  Patient remained in refractory shock with multisystem failure. Did not tolerate PIRRT due to hypotension despite of maximal vasoactive support.  She expired despite numerous CPR rounds.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Computerised tomogram thorax abnormal, Condition aggravated, Confusional state, Death, Device intolerance
Clinical narrative: Hospital Course: 64 y old female patient, severely cachectic, deconditioned with nonischemic CM, LVEF 20-25%, chronic Afib, s/p BIV ICD, Prior DVT, PEs, severe MR/TR, moderate PH, Hypothyroidism, prior Stroke, CKD stage IV, high grade renal artery stenosis, chronic hypoxia, on supplemental O2, recently admitted with hemorrhagic shock, acute blood loss anemia, large right rectus sheath Hematoma, s/p coli embolization of inferior epigastric artery on 11/14 who presented on 11/29 with progressive dyspnea, multiple loose tool and acute confusion. CT chest and abdomen revealed stable size of rectus sheath hematoma, revealed right sided pleural effusion and bibasilar air space disease. SARS COV2 screen was positive. Patient was hypotensive. Improved with IV fluids and dobutamine. She was admitted with hypovolemia, severe sepsis, viral sepsis, SARS COV2 pneumonia. Initially to mod care. She was started on antimicrobial  coverage concerning super imposed bacterial pneumonia.  Patient was transferred to ICU on 12/03 after she became less responsive with progressive hypoxia, lactic acidosis.  Patient was intubated due to progressive hypoxia, worsening hemodynamic status, not tolerating BIPAP and increases in work of breathing. Intubated with RSI first attempt. Dobutamine is decreased to 2.5 mcg/kg/min. Continue Norepinephrine. Add Vasopressin given tachyarrhythmia.  Patient continues to progressively worsen hemodynamically with increase in pressor requirements, oliguria, worsening lactic acidosis. Received multiple boluses of IV fluids. Remained on broad spectrum Abx. Patient developed refractory shock with multiorgan failure ,Progressive metabolic acidosis, renal failure, known advance heart failure with severe systolic heart failure.  On maximal dose epinephrine, Norepinephrine, dobutamine and Vasopressin.   12/07: patient remained in very critical condition. On mechanical ventilation support. ABG showed PH 7.12, Pao2 of 282, Paco2 of 24. Extremely elevated D dimer of > 90 K. Patient is not on sedation. Unresponsive. Right pupil > left. Significant lactic acidosis, significant elevation in AST/ALT. Shock Liver status. INR 3.9. progressive renal failure. Oliguric. High vasoactive support demands with Norepinephrine, epinephrine, vasopressin and dobutamine. To initiate PIRRT.  Patient remained in refractory shock with multisystem failure. Did not tolerate PIRRT due to hypotension despite of maximal vasoactive support.  She expired despite numerous CPR rounds.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Diarrhoea, Dyspnoea, Endotracheal intubation, Fibrin D dimer increased, Haemodynamic instability
Clinical narrative: Hospital Course: 64 y old female patient, severely cachectic, deconditioned with nonischemic CM, LVEF 20-25%, chronic Afib, s/p BIV ICD, Prior DVT, PEs, severe MR/TR, moderate PH, Hypothyroidism, prior Stroke, CKD stage IV, high grade renal artery stenosis, chronic hypoxia, on supplemental O2, recently admitted with hemorrhagic shock, acute blood loss anemia, large right rectus sheath Hematoma, s/p coli embolization of inferior epigastric artery on 11/14 who presented on 11/29 with progressive dyspnea, multiple loose tool and acute confusion. CT chest and abdomen revealed stable size of rectus sheath hematoma, revealed right sided pleural effusion and bibasilar air space disease. SARS COV2 screen was positive. Patient was hypotensive. Improved with IV fluids and dobutamine. She was admitted with hypovolemia, severe sepsis, viral sepsis, SARS COV2 pneumonia. Initially to mod care. She was started on antimicrobial  coverage concerning super imposed bacterial pneumonia.  Patient was transferred to ICU on 12/03 after she became less responsive with progressive hypoxia, lactic acidosis.  Patient was intubated due to progressive hypoxia, worsening hemodynamic status, not tolerating BIPAP and increases in work of breathing. Intubated with RSI first attempt. Dobutamine is decreased to 2.5 mcg/kg/min. Continue Norepinephrine. Add Vasopressin given tachyarrhythmia.  Patient continues to progressively worsen hemodynamically with increase in pressor requirements, oliguria, worsening lactic acidosis. Received multiple boluses of IV fluids. Remained on broad spectrum Abx. Patient developed refractory shock with multiorgan failure ,Progressive metabolic acidosis, renal failure, known advance heart failure with severe systolic heart failure.  On maximal dose epinephrine, Norepinephrine, dobutamine and Vasopressin.   12/07: patient remained in very critical condition. On mechanical ventilation support. ABG showed PH 7.12, Pao2 of 282, Paco2 of 24. Extremely elevated D dimer of > 90 K. Patient is not on sedation. Unresponsive. Right pupil > left. Significant lactic acidosis, significant elevation in AST/ALT. Shock Liver status. INR 3.9. progressive renal failure. Oliguric. High vasoactive support demands with Norepinephrine, epinephrine, vasopressin and dobutamine. To initiate PIRRT.  Patient remained in refractory shock with multisystem failure. Did not tolerate PIRRT due to hypotension despite of maximal vasoactive support.  She expired despite numerous CPR rounds.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Hyporesponsive to stimuli, Hypotension, Hypovolaemia, Hypoxia, Intensive care
Clinical narrative: Hospital Course: 64 y old female patient, severely cachectic, deconditioned with nonischemic CM, LVEF 20-25%, chronic Afib, s/p BIV ICD, Prior DVT, PEs, severe MR/TR, moderate PH, Hypothyroidism, prior Stroke, CKD stage IV, high grade renal artery stenosis, chronic hypoxia, on supplemental O2, recently admitted with hemorrhagic shock, acute blood loss anemia, large right rectus sheath Hematoma, s/p coli embolization of inferior epigastric artery on 11/14 who presented on 11/29 with progressive dyspnea, multiple loose tool and acute confusion. CT chest and abdomen revealed stable size of rectus sheath hematoma, revealed right sided pleural effusion and bibasilar air space disease. SARS COV2 screen was positive. Patient was hypotensive. Improved with IV fluids and dobutamine. She was admitted with hypovolemia, severe sepsis, viral sepsis, SARS COV2 pneumonia. Initially to mod care. She was started on antimicrobial  coverage concerning super imposed bacterial pneumonia.  Patient was transferred to ICU on 12/03 after she became less responsive with progressive hypoxia, lactic acidosis.  Patient was intubated due to progressive hypoxia, worsening hemodynamic status, not tolerating BIPAP and increases in work of breathing. Intubated with RSI first attempt. Dobutamine is decreased to 2.5 mcg/kg/min. Continue Norepinephrine. Add Vasopressin given tachyarrhythmia.  Patient continues to progressively worsen hemodynamically with increase in pressor requirements, oliguria, worsening lactic acidosis. Received multiple boluses of IV fluids. Remained on broad spectrum Abx. Patient developed refractory shock with multiorgan failure ,Progressive metabolic acidosis, renal failure, known advance heart failure with severe systolic heart failure.  On maximal dose epinephrine, Norepinephrine, dobutamine and Vasopressin.   12/07: patient remained in very critical condition. On mechanical ventilation support. ABG showed PH 7.12, Pao2 of 282, Paco2 of 24. Extremely elevated D dimer of > 90 K. Patient is not on sedation. Unresponsive. Right pupil > left. Significant lactic acidosis, significant elevation in AST/ALT. Shock Liver status. INR 3.9. progressive renal failure. Oliguric. High vasoactive support demands with Norepinephrine, epinephrine, vasopressin and dobutamine. To initiate PIRRT.  Patient remained in refractory shock with multisystem failure. Did not tolerate PIRRT due to hypotension despite of maximal vasoactive support.  She expired despite numerous CPR rounds.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: International normalised ratio increased, Ischaemic hepatitis, Lactic acidosis, Left ventricular failure, Lung disorder
Clinical narrative: Hospital Course: 64 y old female patient, severely cachectic, deconditioned with nonischemic CM, LVEF 20-25%, chronic Afib, s/p BIV ICD, Prior DVT, PEs, severe MR/TR, moderate PH, Hypothyroidism, prior Stroke, CKD stage IV, high grade renal artery stenosis, chronic hypoxia, on supplemental O2, recently admitted with hemorrhagic shock, acute blood loss anemia, large right rectus sheath Hematoma, s/p coli embolization of inferior epigastric artery on 11/14 who presented on 11/29 with progressive dyspnea, multiple loose tool and acute confusion. CT chest and abdomen revealed stable size of rectus sheath hematoma, revealed right sided pleural effusion and bibasilar air space disease. SARS COV2 screen was positive. Patient was hypotensive. Improved with IV fluids and dobutamine. She was admitted with hypovolemia, severe sepsis, viral sepsis, SARS COV2 pneumonia. Initially to mod care. She was started on antimicrobial  coverage concerning super imposed bacterial pneumonia.  Patient was transferred to ICU on 12/03 after she became less responsive with progressive hypoxia, lactic acidosis.  Patient was intubated due to progressive hypoxia, worsening hemodynamic status, not tolerating BIPAP and increases in work of breathing. Intubated with RSI first attempt. Dobutamine is decreased to 2.5 mcg/kg/min. Continue Norepinephrine. Add Vasopressin given tachyarrhythmia.  Patient continues to progressively worsen hemodynamically with increase in pressor requirements, oliguria, worsening lactic acidosis. Received multiple boluses of IV fluids. Remained on broad spectrum Abx. Patient developed refractory shock with multiorgan failure ,Progressive metabolic acidosis, renal failure, known advance heart failure with severe systolic heart failure.  On maximal dose epinephrine, Norepinephrine, dobutamine and Vasopressin.   12/07: patient remained in very critical condition. On mechanical ventilation support. ABG showed PH 7.12, Pao2 of 282, Paco2 of 24. Extremely elevated D dimer of > 90 K. Patient is not on sedation. Unresponsive. Right pupil > left. Significant lactic acidosis, significant elevation in AST/ALT. Shock Liver status. INR 3.9. progressive renal failure. Oliguric. High vasoactive support demands with Norepinephrine, epinephrine, vasopressin and dobutamine. To initiate PIRRT.  Patient remained in refractory shock with multisystem failure. Did not tolerate PIRRT due to hypotension despite of maximal vasoactive support.  She expired despite numerous CPR rounds.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Mechanical ventilation, Metabolic acidosis, Multiple organ dysfunction syndrome, Oliguria, PCO2 decreased
Clinical narrative: Hospital Course: 64 y old female patient, severely cachectic, deconditioned with nonischemic CM, LVEF 20-25%, chronic Afib, s/p BIV ICD, Prior DVT, PEs, severe MR/TR, moderate PH, Hypothyroidism, prior Stroke, CKD stage IV, high grade renal artery stenosis, chronic hypoxia, on supplemental O2, recently admitted with hemorrhagic shock, acute blood loss anemia, large right rectus sheath Hematoma, s/p coli embolization of inferior epigastric artery on 11/14 who presented on 11/29 with progressive dyspnea, multiple loose tool and acute confusion. CT chest and abdomen revealed stable size of rectus sheath hematoma, revealed right sided pleural effusion and bibasilar air space disease. SARS COV2 screen was positive. Patient was hypotensive. Improved with IV fluids and dobutamine. She was admitted with hypovolemia, severe sepsis, viral sepsis, SARS COV2 pneumonia. Initially to mod care. She was started on antimicrobial  coverage concerning super imposed bacterial pneumonia.  Patient was transferred to ICU on 12/03 after she became less responsive with progressive hypoxia, lactic acidosis.  Patient was intubated due to progressive hypoxia, worsening hemodynamic status, not tolerating BIPAP and increases in work of breathing. Intubated with RSI first attempt. Dobutamine is decreased to 2.5 mcg/kg/min. Continue Norepinephrine. Add Vasopressin given tachyarrhythmia.  Patient continues to progressively worsen hemodynamically with increase in pressor requirements, oliguria, worsening lactic acidosis. Received multiple boluses of IV fluids. Remained on broad spectrum Abx. Patient developed refractory shock with multiorgan failure ,Progressive metabolic acidosis, renal failure, known advance heart failure with severe systolic heart failure.  On maximal dose epinephrine, Norepinephrine, dobutamine and Vasopressin.   12/07: patient remained in very critical condition. On mechanical ventilation support. ABG showed PH 7.12, Pao2 of 282, Paco2 of 24. Extremely elevated D dimer of > 90 K. Patient is not on sedation. Unresponsive. Right pupil > left. Significant lactic acidosis, significant elevation in AST/ALT. Shock Liver status. INR 3.9. progressive renal failure. Oliguric. High vasoactive support demands with Norepinephrine, epinephrine, vasopressin and dobutamine. To initiate PIRRT.  Patient remained in refractory shock with multisystem failure. Did not tolerate PIRRT due to hypotension despite of maximal vasoactive support.  She expired despite numerous CPR rounds.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: PO2 increased, Pleural effusion, Positive airway pressure therapy, Pupils unequal, Renal failure
Clinical narrative: Hospital Course: 64 y old female patient, severely cachectic, deconditioned with nonischemic CM, LVEF 20-25%, chronic Afib, s/p BIV ICD, Prior DVT, PEs, severe MR/TR, moderate PH, Hypothyroidism, prior Stroke, CKD stage IV, high grade renal artery stenosis, chronic hypoxia, on supplemental O2, recently admitted with hemorrhagic shock, acute blood loss anemia, large right rectus sheath Hematoma, s/p coli embolization of inferior epigastric artery on 11/14 who presented on 11/29 with progressive dyspnea, multiple loose tool and acute confusion. CT chest and abdomen revealed stable size of rectus sheath hematoma, revealed right sided pleural effusion and bibasilar air space disease. SARS COV2 screen was positive. Patient was hypotensive. Improved with IV fluids and dobutamine. She was admitted with hypovolemia, severe sepsis, viral sepsis, SARS COV2 pneumonia. Initially to mod care. She was started on antimicrobial  coverage concerning super imposed bacterial pneumonia.  Patient was transferred to ICU on 12/03 after she became less responsive with progressive hypoxia, lactic acidosis.  Patient was intubated due to progressive hypoxia, worsening hemodynamic status, not tolerating BIPAP and increases in work of breathing. Intubated with RSI first attempt. Dobutamine is decreased to 2.5 mcg/kg/min. Continue Norepinephrine. Add Vasopressin given tachyarrhythmia.  Patient continues to progressively worsen hemodynamically with increase in pressor requirements, oliguria, worsening lactic acidosis. Received multiple boluses of IV fluids. Remained on broad spectrum Abx. Patient developed refractory shock with multiorgan failure ,Progressive metabolic acidosis, renal failure, known advance heart failure with severe systolic heart failure.  On maximal dose epinephrine, Norepinephrine, dobutamine and Vasopressin.   12/07: patient remained in very critical condition. On mechanical ventilation support. ABG showed PH 7.12, Pao2 of 282, Paco2 of 24. Extremely elevated D dimer of > 90 K. Patient is not on sedation. Unresponsive. Right pupil > left. Significant lactic acidosis, significant elevation in AST/ALT. Shock Liver status. INR 3.9. progressive renal failure. Oliguric. High vasoactive support demands with Norepinephrine, epinephrine, vasopressin and dobutamine. To initiate PIRRT.  Patient remained in refractory shock with multisystem failure. Did not tolerate PIRRT due to hypotension despite of maximal vasoactive support.  She expired despite numerous CPR rounds.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Renal replacement therapy, Resuscitation, SARS-CoV-2 test positive, Sepsis, Shock
Clinical narrative: Hospital Course: 64 y old female patient, severely cachectic, deconditioned with nonischemic CM, LVEF 20-25%, chronic Afib, s/p BIV ICD, Prior DVT, PEs, severe MR/TR, moderate PH, Hypothyroidism, prior Stroke, CKD stage IV, high grade renal artery stenosis, chronic hypoxia, on supplemental O2, recently admitted with hemorrhagic shock, acute blood loss anemia, large right rectus sheath Hematoma, s/p coli embolization of inferior epigastric artery on 11/14 who presented on 11/29 with progressive dyspnea, multiple loose tool and acute confusion. CT chest and abdomen revealed stable size of rectus sheath hematoma, revealed right sided pleural effusion and bibasilar air space disease. SARS COV2 screen was positive. Patient was hypotensive. Improved with IV fluids and dobutamine. She was admitted with hypovolemia, severe sepsis, viral sepsis, SARS COV2 pneumonia. Initially to mod care. She was started on antimicrobial  coverage concerning super imposed bacterial pneumonia.  Patient was transferred to ICU on 12/03 after she became less responsive with progressive hypoxia, lactic acidosis.  Patient was intubated due to progressive hypoxia, worsening hemodynamic status, not tolerating BIPAP and increases in work of breathing. Intubated with RSI first attempt. Dobutamine is decreased to 2.5 mcg/kg/min. Continue Norepinephrine. Add Vasopressin given tachyarrhythmia.  Patient continues to progressively worsen hemodynamically with increase in pressor requirements, oliguria, worsening lactic acidosis. Received multiple boluses of IV fluids. Remained on broad spectrum Abx. Patient developed refractory shock with multiorgan failure ,Progressive metabolic acidosis, renal failure, known advance heart failure with severe systolic heart failure.  On maximal dose epinephrine, Norepinephrine, dobutamine and Vasopressin.   12/07: patient remained in very critical condition. On mechanical ventilation support. ABG showed PH 7.12, Pao2 of 282, Paco2 of 24. Extremely elevated D dimer of > 90 K. Patient is not on sedation. Unresponsive. Right pupil > left. Significant lactic acidosis, significant elevation in AST/ALT. Shock Liver status. INR 3.9. progressive renal failure. Oliguric. High vasoactive support demands with Norepinephrine, epinephrine, vasopressin and dobutamine. To initiate PIRRT.  Patient remained in refractory shock with multisystem failure. Did not tolerate PIRRT due to hypotension despite of maximal vasoactive support.  She expired despite numerous CPR rounds.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Shock haemorrhagic, Tachyarrhythmia, Therapeutic embolisation, Unresponsive to stimuli, Viral sepsis
Clinical narrative: Hospital Course: 64 y old female patient, severely cachectic, deconditioned with nonischemic CM, LVEF 20-25%, chronic Afib, s/p BIV ICD, Prior DVT, PEs, severe MR/TR, moderate PH, Hypothyroidism, prior Stroke, CKD stage IV, high grade renal artery stenosis, chronic hypoxia, on supplemental O2, recently admitted with hemorrhagic shock, acute blood loss anemia, large right rectus sheath Hematoma, s/p coli embolization of inferior epigastric artery on 11/14 who presented on 11/29 with progressive dyspnea, multiple loose tool and acute confusion. CT chest and abdomen revealed stable size of rectus sheath hematoma, revealed right sided pleural effusion and bibasilar air space disease. SARS COV2 screen was positive. Patient was hypotensive. Improved with IV fluids and dobutamine. She was admitted with hypovolemia, severe sepsis, viral sepsis, SARS COV2 pneumonia. Initially to mod care. She was started on antimicrobial  coverage concerning super imposed bacterial pneumonia.  Patient was transferred to ICU on 12/03 after she became less responsive with progressive hypoxia, lactic acidosis.  Patient was intubated due to progressive hypoxia, worsening hemodynamic status, not tolerating BIPAP and increases in work of breathing. Intubated with RSI first attempt. Dobutamine is decreased to 2.5 mcg/kg/min. Continue Norepinephrine. Add Vasopressin given tachyarrhythmia.  Patient continues to progressively worsen hemodynamically with increase in pressor requirements, oliguria, worsening lactic acidosis. Received multiple boluses of IV fluids. Remained on broad spectrum Abx. Patient developed refractory shock with multiorgan failure ,Progressive metabolic acidosis, renal failure, known advance heart failure with severe systolic heart failure.  On maximal dose epinephrine, Norepinephrine, dobutamine and Vasopressin.   12/07: patient remained in very critical condition. On mechanical ventilation support. ABG showed PH 7.12, Pao2 of 282, Paco2 of 24. Extremely elevated D dimer of > 90 K. Patient is not on sedation. Unresponsive. Right pupil > left. Significant lactic acidosis, significant elevation in AST/ALT. Shock Liver status. INR 3.9. progressive renal failure. Oliguric. High vasoactive support demands with Norepinephrine, epinephrine, vasopressin and dobutamine. To initiate PIRRT.  Patient remained in refractory shock with multisystem failure. Did not tolerate PIRRT due to hypotension despite of maximal vasoactive support.  She expired despite numerous CPR rounds.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Acute hepatic failure, Acute kidney injury, Acute respiratory failure, COVID-19, COVID-19 pneumonia
Clinical narrative: Hospital Course: 64 y old female patient, severely cachectic, deconditioned with nonischemic CM, LVEF 20-25%, chronic Afib, s/p BIV ICD, Prior DVT, PEs, severe MR/TR, moderate PH, Hypothyroidism, prior Stroke, CKD stage IV, high grade renal artery stenosis, chronic hypoxia, on supplemental O2, recently admitted with hemorrhagic shock, acute blood loss anemia, large right rectus sheath Hematoma, s/p coli embolization of inferior epigastric artery on 11/14 who presented on 11/29 with progressive dyspnea, multiple loose tool and acute confusion. CT chest and abdomen revealed stable size of rectus sheath hematoma, revealed right sided pleural effusion and bibasilar air space disease. SARS COV2 screen was positive. Patient was hypotensive. Improved with IV fluids and dobutamine. She was admitted with hypovolemia, severe sepsis, viral sepsis, SARS COV2 pneumonia. Initially to mod care. She was started on antimicrobial  coverage concerning super imposed bacterial pneumonia.  Patient was transferred to ICU on 12/03 after she became less responsive with progressive hypoxia, lactic acidosis.  Patient was intubated due to progressive hypoxia, worsening hemodynamic status, not tolerating BIPAP and increases in work of breathing. Intubated with RSI first attempt. Dobutamine is decreased to 2.5 mcg/kg/min. Continue Norepinephrine. Add Vasopressin given tachyarrhythmia.  Patient continues to progressively worsen hemodynamically with increase in pressor requirements, oliguria, worsening lactic acidosis. Received multiple boluses of IV fluids. Remained on broad spectrum Abx. Patient developed refractory shock with multiorgan failure ,Progressive metabolic acidosis, renal failure, known advance heart failure with severe systolic heart failure.  On maximal dose epinephrine, Norepinephrine, dobutamine and Vasopressin.   12/07: patient remained in very critical condition. On mechanical ventilation support. ABG showed PH 7.12, Pao2 of 282, Paco2 of 24. Extremely elevated D dimer of > 90 K. Patient is not on sedation. Unresponsive. Right pupil > left. Significant lactic acidosis, significant elevation in AST/ALT. Shock Liver status. INR 3.9. progressive renal failure. Oliguric. High vasoactive support demands with Norepinephrine, epinephrine, vasopressin and dobutamine. To initiate PIRRT.  Patient remained in refractory shock with multisystem failure. Did not tolerate PIRRT due to hypotension despite of maximal vasoactive support.  She expired despite numerous CPR rounds.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Cardiac failure acute, Cardiac failure congestive, Cardiogenic shock, Cardiohepatic syndrome, Cardiomyopathy
Clinical narrative: Hospital Course: 64 y old female patient, severely cachectic, deconditioned with nonischemic CM, LVEF 20-25%, chronic Afib, s/p BIV ICD, Prior DVT, PEs, severe MR/TR, moderate PH, Hypothyroidism, prior Stroke, CKD stage IV, high grade renal artery stenosis, chronic hypoxia, on supplemental O2, recently admitted with hemorrhagic shock, acute blood loss anemia, large right rectus sheath Hematoma, s/p coli embolization of inferior epigastric artery on 11/14 who presented on 11/29 with progressive dyspnea, multiple loose tool and acute confusion. CT chest and abdomen revealed stable size of rectus sheath hematoma, revealed right sided pleural effusion and bibasilar air space disease. SARS COV2 screen was positive. Patient was hypotensive. Improved with IV fluids and dobutamine. She was admitted with hypovolemia, severe sepsis, viral sepsis, SARS COV2 pneumonia. Initially to mod care. She was started on antimicrobial  coverage concerning super imposed bacterial pneumonia.  Patient was transferred to ICU on 12/03 after she became less responsive with progressive hypoxia, lactic acidosis.  Patient was intubated due to progressive hypoxia, worsening hemodynamic status, not tolerating BIPAP and increases in work of breathing. Intubated with RSI first attempt. Dobutamine is decreased to 2.5 mcg/kg/min. Continue Norepinephrine. Add Vasopressin given tachyarrhythmia.  Patient continues to progressively worsen hemodynamically with increase in pressor requirements, oliguria, worsening lactic acidosis. Received multiple boluses of IV fluids. Remained on broad spectrum Abx. Patient developed refractory shock with multiorgan failure ,Progressive metabolic acidosis, renal failure, known advance heart failure with severe systolic heart failure.  On maximal dose epinephrine, Norepinephrine, dobutamine and Vasopressin.   12/07: patient remained in very critical condition. On mechanical ventilation support. ABG showed PH 7.12, Pao2 of 282, Paco2 of 24. Extremely elevated D dimer of > 90 K. Patient is not on sedation. Unresponsive. Right pupil > left. Significant lactic acidosis, significant elevation in AST/ALT. Shock Liver status. INR 3.9. progressive renal failure. Oliguric. High vasoactive support demands with Norepinephrine, epinephrine, vasopressin and dobutamine. To initiate PIRRT.  Patient remained in refractory shock with multisystem failure. Did not tolerate PIRRT due to hypotension despite of maximal vasoactive support.  She expired despite numerous CPR rounds.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Chronic kidney disease, Condition aggravated, Death, Dyspnoea, Intensive care
Clinical narrative: Hospital Course: 64 y old female patient, severely cachectic, deconditioned with nonischemic CM, LVEF 20-25%, chronic Afib, s/p BIV ICD, Prior DVT, PEs, severe MR/TR, moderate PH, Hypothyroidism, prior Stroke, CKD stage IV, high grade renal artery stenosis, chronic hypoxia, on supplemental O2, recently admitted with hemorrhagic shock, acute blood loss anemia, large right rectus sheath Hematoma, s/p coli embolization of inferior epigastric artery on 11/14 who presented on 11/29 with progressive dyspnea, multiple loose tool and acute confusion. CT chest and abdomen revealed stable size of rectus sheath hematoma, revealed right sided pleural effusion and bibasilar air space disease. SARS COV2 screen was positive. Patient was hypotensive. Improved with IV fluids and dobutamine. She was admitted with hypovolemia, severe sepsis, viral sepsis, SARS COV2 pneumonia. Initially to mod care. She was started on antimicrobial  coverage concerning super imposed bacterial pneumonia.  Patient was transferred to ICU on 12/03 after she became less responsive with progressive hypoxia, lactic acidosis.  Patient was intubated due to progressive hypoxia, worsening hemodynamic status, not tolerating BIPAP and increases in work of breathing. Intubated with RSI first attempt. Dobutamine is decreased to 2.5 mcg/kg/min. Continue Norepinephrine. Add Vasopressin given tachyarrhythmia.  Patient continues to progressively worsen hemodynamically with increase in pressor requirements, oliguria, worsening lactic acidosis. Received multiple boluses of IV fluids. Remained on broad spectrum Abx. Patient developed refractory shock with multiorgan failure ,Progressive metabolic acidosis, renal failure, known advance heart failure with severe systolic heart failure.  On maximal dose epinephrine, Norepinephrine, dobutamine and Vasopressin.   12/07: patient remained in very critical condition. On mechanical ventilation support. ABG showed PH 7.12, Pao2 of 282, Paco2 of 24. Extremely elevated D dimer of > 90 K. Patient is not on sedation. Unresponsive. Right pupil > left. Significant lactic acidosis, significant elevation in AST/ALT. Shock Liver status. INR 3.9. progressive renal failure. Oliguric. High vasoactive support demands with Norepinephrine, epinephrine, vasopressin and dobutamine. To initiate PIRRT.  Patient remained in refractory shock with multisystem failure. Did not tolerate PIRRT due to hypotension despite of maximal vasoactive support.  She expired despite numerous CPR rounds.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Ischaemic hepatitis, Lactic acidosis, Left ventricular failure, Liver disorder, Pneumonia bacterial
Clinical narrative: Hospital Course: 64 y old female patient, severely cachectic, deconditioned with nonischemic CM, LVEF 20-25%, chronic Afib, s/p BIV ICD, Prior DVT, PEs, severe MR/TR, moderate PH, Hypothyroidism, prior Stroke, CKD stage IV, high grade renal artery stenosis, chronic hypoxia, on supplemental O2, recently admitted with hemorrhagic shock, acute blood loss anemia, large right rectus sheath Hematoma, s/p coli embolization of inferior epigastric artery on 11/14 who presented on 11/29 with progressive dyspnea, multiple loose tool and acute confusion. CT chest and abdomen revealed stable size of rectus sheath hematoma, revealed right sided pleural effusion and bibasilar air space disease. SARS COV2 screen was positive. Patient was hypotensive. Improved with IV fluids and dobutamine. She was admitted with hypovolemia, severe sepsis, viral sepsis, SARS COV2 pneumonia. Initially to mod care. She was started on antimicrobial  coverage concerning super imposed bacterial pneumonia.  Patient was transferred to ICU on 12/03 after she became less responsive with progressive hypoxia, lactic acidosis.  Patient was intubated due to progressive hypoxia, worsening hemodynamic status, not tolerating BIPAP and increases in work of breathing. Intubated with RSI first attempt. Dobutamine is decreased to 2.5 mcg/kg/min. Continue Norepinephrine. Add Vasopressin given tachyarrhythmia.  Patient continues to progressively worsen hemodynamically with increase in pressor requirements, oliguria, worsening lactic acidosis. Received multiple boluses of IV fluids. Remained on broad spectrum Abx. Patient developed refractory shock with multiorgan failure ,Progressive metabolic acidosis, renal failure, known advance heart failure with severe systolic heart failure.  On maximal dose epinephrine, Norepinephrine, dobutamine and Vasopressin.   12/07: patient remained in very critical condition. On mechanical ventilation support. ABG showed PH 7.12, Pao2 of 282, Paco2 of 24. Extremely elevated D dimer of > 90 K. Patient is not on sedation. Unresponsive. Right pupil > left. Significant lactic acidosis, significant elevation in AST/ALT. Shock Liver status. INR 3.9. progressive renal failure. Oliguric. High vasoactive support demands with Norepinephrine, epinephrine, vasopressin and dobutamine. To initiate PIRRT.  Patient remained in refractory shock with multisystem failure. Did not tolerate PIRRT due to hypotension despite of maximal vasoactive support.  She expired despite numerous CPR rounds.