chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 81.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Apnoeic attack, Bacteraemia, Blood culture positive, Blood gases
Clinical narrative: Discharge Provider: MD  Primary Care Provider : DO  Admitting Service: Internal Medicine Service Admission Date: 12/24/2022 Discharge Date: 12/29/2022 COVID positive Date 12/24/2022 PRESENTING PROBLEM:  Acute respiratory failure with hypoxia [J96.01] Hypothermia, initial encounter [T68.XXXA] Acute on chronic respiratory failure with hypoxia and hypercapnia [J96.21, J96.22] Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present [A41.9] COVID-19 [U07.1] Bacteremia [R78.81]   HOSPITAL COURSE:   82 year old female with paroxysmal atrial fib, ESRD (on HD TIW via AVF), and HTN presented for SOB after having URI symptoms several weeks ago and missing HD run 12/23 per granddaughter.  While being evaluated by EMS went apneic (no loss of pulses).  She was bagged in transit and intubated in the ED.  COVID-19 was (+) (vaccinated X3, overdue for booster, was COVID+ in October).  CXR showed diffuse opacities, VBG 6.9/>100, lactate 4.4, BNP 6k.  She was given Zosyn / Vanco / Decadron.  Following intubation, required NE.  TTE showed EF 30% with severe global hypokinesis.  NE was exchanged for Epi gtt.  She was seen by cardiology with recommended followup TTE when clincally improved.  She recieved IHD run 12/24 and tolerated removal of 1.5Ls.  She weaned off Epi 12/25.  Blood cultures from admission were (+) 2:2 for strept - mitis / oralis identified (followup 12/25 NGTD).  ID was consulted.  Her respiratory status improved and she was extubated 12/25, oxygen requirement significantly improved, eventually did not require any oxygen, repeat blood cultures remained negative since 12/25.  Cardiology recommended initiating goal-directed medical therapy, she was started on low-dose Coreg and Entresto, outpatient follow-up with Cardiology was recommended.  Infectious Disease recommended continuing ceftriaxone inpatient in transition to amoxicillin 1 g daily to complete total 14 days, PT and OT did not recommend any skilled therapy.  Doing well discharge home in stable condition, recommended follow-up with PCP in 1 week, instructions discussed in detail with patient who verbalized understanding.
Age: 81.0
Sex: F
Vaccine: COVID19
Symptoms: Blood lactic acid, Brain natriuretic peptide increased, COVID-19, Chest X-ray abnormal, Dyspnoea
Clinical narrative: Discharge Provider: MD  Primary Care Provider : DO  Admitting Service: Internal Medicine Service Admission Date: 12/24/2022 Discharge Date: 12/29/2022 COVID positive Date 12/24/2022 PRESENTING PROBLEM:  Acute respiratory failure with hypoxia [J96.01] Hypothermia, initial encounter [T68.XXXA] Acute on chronic respiratory failure with hypoxia and hypercapnia [J96.21, J96.22] Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present [A41.9] COVID-19 [U07.1] Bacteremia [R78.81]   HOSPITAL COURSE:   82 year old female with paroxysmal atrial fib, ESRD (on HD TIW via AVF), and HTN presented for SOB after having URI symptoms several weeks ago and missing HD run 12/23 per granddaughter.  While being evaluated by EMS went apneic (no loss of pulses).  She was bagged in transit and intubated in the ED.  COVID-19 was (+) (vaccinated X3, overdue for booster, was COVID+ in October).  CXR showed diffuse opacities, VBG 6.9/>100, lactate 4.4, BNP 6k.  She was given Zosyn / Vanco / Decadron.  Following intubation, required NE.  TTE showed EF 30% with severe global hypokinesis.  NE was exchanged for Epi gtt.  She was seen by cardiology with recommended followup TTE when clincally improved.  She recieved IHD run 12/24 and tolerated removal of 1.5Ls.  She weaned off Epi 12/25.  Blood cultures from admission were (+) 2:2 for strept - mitis / oralis identified (followup 12/25 NGTD).  ID was consulted.  Her respiratory status improved and she was extubated 12/25, oxygen requirement significantly improved, eventually did not require any oxygen, repeat blood cultures remained negative since 12/25.  Cardiology recommended initiating goal-directed medical therapy, she was started on low-dose Coreg and Entresto, outpatient follow-up with Cardiology was recommended.  Infectious Disease recommended continuing ceftriaxone inpatient in transition to amoxicillin 1 g daily to complete total 14 days, PT and OT did not recommend any skilled therapy.  Doing well discharge home in stable condition, recommended follow-up with PCP in 1 week, instructions discussed in detail with patient who verbalized understanding.
Age: 81.0
Sex: F
Vaccine: COVID19
Symptoms: Echocardiogram abnormal, Ejection fraction decreased, Endotracheal intubation, Extubation, Hypokinesia
Clinical narrative: Discharge Provider: MD  Primary Care Provider : DO  Admitting Service: Internal Medicine Service Admission Date: 12/24/2022 Discharge Date: 12/29/2022 COVID positive Date 12/24/2022 PRESENTING PROBLEM:  Acute respiratory failure with hypoxia [J96.01] Hypothermia, initial encounter [T68.XXXA] Acute on chronic respiratory failure with hypoxia and hypercapnia [J96.21, J96.22] Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present [A41.9] COVID-19 [U07.1] Bacteremia [R78.81]   HOSPITAL COURSE:   82 year old female with paroxysmal atrial fib, ESRD (on HD TIW via AVF), and HTN presented for SOB after having URI symptoms several weeks ago and missing HD run 12/23 per granddaughter.  While being evaluated by EMS went apneic (no loss of pulses).  She was bagged in transit and intubated in the ED.  COVID-19 was (+) (vaccinated X3, overdue for booster, was COVID+ in October).  CXR showed diffuse opacities, VBG 6.9/>100, lactate 4.4, BNP 6k.  She was given Zosyn / Vanco / Decadron.  Following intubation, required NE.  TTE showed EF 30% with severe global hypokinesis.  NE was exchanged for Epi gtt.  She was seen by cardiology with recommended followup TTE when clincally improved.  She recieved IHD run 12/24 and tolerated removal of 1.5Ls.  She weaned off Epi 12/25.  Blood cultures from admission were (+) 2:2 for strept - mitis / oralis identified (followup 12/25 NGTD).  ID was consulted.  Her respiratory status improved and she was extubated 12/25, oxygen requirement significantly improved, eventually did not require any oxygen, repeat blood cultures remained negative since 12/25.  Cardiology recommended initiating goal-directed medical therapy, she was started on low-dose Coreg and Entresto, outpatient follow-up with Cardiology was recommended.  Infectious Disease recommended continuing ceftriaxone inpatient in transition to amoxicillin 1 g daily to complete total 14 days, PT and OT did not recommend any skilled therapy.  Doing well discharge home in stable condition, recommended follow-up with PCP in 1 week, instructions discussed in detail with patient who verbalized understanding.
Age: 81.0
Sex: F
Vaccine: COVID19
Symptoms: Hypothermia, Lung opacity, Respiratory failure, Respiratory symptom, SARS-CoV-2 test positive
Clinical narrative: Discharge Provider: MD  Primary Care Provider : DO  Admitting Service: Internal Medicine Service Admission Date: 12/24/2022 Discharge Date: 12/29/2022 COVID positive Date 12/24/2022 PRESENTING PROBLEM:  Acute respiratory failure with hypoxia [J96.01] Hypothermia, initial encounter [T68.XXXA] Acute on chronic respiratory failure with hypoxia and hypercapnia [J96.21, J96.22] Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present [A41.9] COVID-19 [U07.1] Bacteremia [R78.81]   HOSPITAL COURSE:   82 year old female with paroxysmal atrial fib, ESRD (on HD TIW via AVF), and HTN presented for SOB after having URI symptoms several weeks ago and missing HD run 12/23 per granddaughter.  While being evaluated by EMS went apneic (no loss of pulses).  She was bagged in transit and intubated in the ED.  COVID-19 was (+) (vaccinated X3, overdue for booster, was COVID+ in October).  CXR showed diffuse opacities, VBG 6.9/>100, lactate 4.4, BNP 6k.  She was given Zosyn / Vanco / Decadron.  Following intubation, required NE.  TTE showed EF 30% with severe global hypokinesis.  NE was exchanged for Epi gtt.  She was seen by cardiology with recommended followup TTE when clincally improved.  She recieved IHD run 12/24 and tolerated removal of 1.5Ls.  She weaned off Epi 12/25.  Blood cultures from admission were (+) 2:2 for strept - mitis / oralis identified (followup 12/25 NGTD).  ID was consulted.  Her respiratory status improved and she was extubated 12/25, oxygen requirement significantly improved, eventually did not require any oxygen, repeat blood cultures remained negative since 12/25.  Cardiology recommended initiating goal-directed medical therapy, she was started on low-dose Coreg and Entresto, outpatient follow-up with Cardiology was recommended.  Infectious Disease recommended continuing ceftriaxone inpatient in transition to amoxicillin 1 g daily to complete total 14 days, PT and OT did not recommend any skilled therapy.  Doing well discharge home in stable condition, recommended follow-up with PCP in 1 week, instructions discussed in detail with patient who verbalized understanding.
Age: 81.0
Sex: F
Vaccine: COVID19
Symptoms: Sepsis, Streptococcus test positive
Clinical narrative: Discharge Provider: MD  Primary Care Provider : DO  Admitting Service: Internal Medicine Service Admission Date: 12/24/2022 Discharge Date: 12/29/2022 COVID positive Date 12/24/2022 PRESENTING PROBLEM:  Acute respiratory failure with hypoxia [J96.01] Hypothermia, initial encounter [T68.XXXA] Acute on chronic respiratory failure with hypoxia and hypercapnia [J96.21, J96.22] Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present [A41.9] COVID-19 [U07.1] Bacteremia [R78.81]   HOSPITAL COURSE:   82 year old female with paroxysmal atrial fib, ESRD (on HD TIW via AVF), and HTN presented for SOB after having URI symptoms several weeks ago and missing HD run 12/23 per granddaughter.  While being evaluated by EMS went apneic (no loss of pulses).  She was bagged in transit and intubated in the ED.  COVID-19 was (+) (vaccinated X3, overdue for booster, was COVID+ in October).  CXR showed diffuse opacities, VBG 6.9/>100, lactate 4.4, BNP 6k.  She was given Zosyn / Vanco / Decadron.  Following intubation, required NE.  TTE showed EF 30% with severe global hypokinesis.  NE was exchanged for Epi gtt.  She was seen by cardiology with recommended followup TTE when clincally improved.  She recieved IHD run 12/24 and tolerated removal of 1.5Ls.  She weaned off Epi 12/25.  Blood cultures from admission were (+) 2:2 for strept - mitis / oralis identified (followup 12/25 NGTD).  ID was consulted.  Her respiratory status improved and she was extubated 12/25, oxygen requirement significantly improved, eventually did not require any oxygen, repeat blood cultures remained negative since 12/25.  Cardiology recommended initiating goal-directed medical therapy, she was started on low-dose Coreg and Entresto, outpatient follow-up with Cardiology was recommended.  Infectious Disease recommended continuing ceftriaxone inpatient in transition to amoxicillin 1 g daily to complete total 14 days, PT and OT did not recommend any skilled therapy.  Doing well discharge home in stable condition, recommended follow-up with PCP in 1 week, instructions discussed in detail with patient who verbalized understanding.
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Blister, Herpes zoster, Hyperaesthesia, Pain, Pruritus
Clinical narrative: 08/21/21    - I started itching and hurting bad. I thought I was having a sciatic nerve attack.  It was across that nerve below my waste in your back, went down your legs and wrapped around from my thigh to my hip and back around the front and down the right leg.  The next day or two, I broke out in a rash. In another day or two, I had small blisters that hurt.  I saw my doctor on 8/23/21.  She prescribed pain pills.  I began taking the pain pills that day which helped with the pain. The rash lasted a couple of weeks.  The pain lasted a couple of months. Then the sensitivity, as in touching and pressing, was very sensitive until the end of the year or first of 2022.   I have recovered from the shingles.
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Rash
Clinical narrative: 08/21/21    - I started itching and hurting bad. I thought I was having a sciatic nerve attack.  It was across that nerve below my waste in your back, went down your legs and wrapped around from my thigh to my hip and back around the front and down the right leg.  The next day or two, I broke out in a rash. In another day or two, I had small blisters that hurt.  I saw my doctor on 8/23/21.  She prescribed pain pills.  I began taking the pain pills that day which helped with the pain. The rash lasted a couple of weeks.  The pain lasted a couple of months. Then the sensitivity, as in touching and pressing, was very sensitive until the end of the year or first of 2022.   I have recovered from the shingles.
Age: 84.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, Diarrhoea, Dyspnoea, SARS-CoV-2 test positive
Clinical narrative: Tested COVID-19 positive, resulted in hospital admission. Symptoms included shortness of breath and diarrhea.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Blood urine present, Burning sensation, COVID-19, Cholecystectomy, Cholelithiasis
Clinical narrative: So the first time I had the problem was 12/30/2021 but the day before I had discomfort in my lower back I woke the morning with a burning and blood in my Urine my doctor thought I had perhaps passed kidney stone and sent to me to a Urologist and that doctor ran several tests. On 05/15/2022 I had another episode, I was then prescribed cefdinir. On 06/11/2022 I had the same episode again, another prescription of cefdinir was given me on 06/22/2022 an abdominal ultrasound showed numerous gall stones. On 07/10/2022 I also tested positive for COVID-19 as well and was prescribed PAXLOVID and fully recovered. On 07/21/2022 I had a surgery to remove my gallbladder. On 12/15/2022, 12/29/2022 and 01/02/2023 I had additional episodes of burning and blood in my urine. Doctors are unsure if I am passing kidney stones and cause unknown and more tests are forthcoming.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Cystoscopy normal, Laboratory test, Lung disorder, Musculoskeletal discomfort, SARS-CoV-2 test positive
Clinical narrative: So the first time I had the problem was 12/30/2021 but the day before I had discomfort in my lower back I woke the morning with a burning and blood in my Urine my doctor thought I had perhaps passed kidney stone and sent to me to a Urologist and that doctor ran several tests. On 05/15/2022 I had another episode, I was then prescribed cefdinir. On 06/11/2022 I had the same episode again, another prescription of cefdinir was given me on 06/22/2022 an abdominal ultrasound showed numerous gall stones. On 07/10/2022 I also tested positive for COVID-19 as well and was prescribed PAXLOVID and fully recovered. On 07/21/2022 I had a surgery to remove my gallbladder. On 12/15/2022, 12/29/2022 and 01/02/2023 I had additional episodes of burning and blood in my urine. Doctors are unsure if I am passing kidney stones and cause unknown and more tests are forthcoming.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Ultrasound abdomen abnormal, Urogram abnormal
Clinical narrative: So the first time I had the problem was 12/30/2021 but the day before I had discomfort in my lower back I woke the morning with a burning and blood in my Urine my doctor thought I had perhaps passed kidney stone and sent to me to a Urologist and that doctor ran several tests. On 05/15/2022 I had another episode, I was then prescribed cefdinir. On 06/11/2022 I had the same episode again, another prescription of cefdinir was given me on 06/22/2022 an abdominal ultrasound showed numerous gall stones. On 07/10/2022 I also tested positive for COVID-19 as well and was prescribed PAXLOVID and fully recovered. On 07/21/2022 I had a surgery to remove my gallbladder. On 12/15/2022, 12/29/2022 and 01/02/2023 I had additional episodes of burning and blood in my urine. Doctors are unsure if I am passing kidney stones and cause unknown and more tests are forthcoming.
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Chest X-ray abnormal, Cough, Dyspnoea, SARS-CoV-2 test positive
Clinical narrative: Tested COVID-19 positive, resulted in hospital stay and abnormal chest x-ray. Symptoms include cough and shortness of breath.
Age: 9.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal pain, Acute kidney injury, Bacterial test positive, Blood bicarbonate, Blood chloride
Clinical narrative: Discharge Provider:   Primary Care Physician at Discharge:  Admission Date: 12/22/2022  Discharge Date: 12/29/2022 COVID positive date: 12/22/2022 DKA, type 1, not at goal [E10.10] AKI (acute kidney injury) [N17.9]   HOSPITAL COURSE: Pt. is a 10-year-old female presenting with severe DKA from new onset T1DM, possibly triggered by COVID-19 infection. She was obtunded when she presented to the outside hospital and was improved, but somnolent, upon arrival to our ICU on 12/22. She did receive mannitol x1 for concern of cerebral edema. Insulin was started at 0.1 units/kg/hr and her fluids were adjusted based on her potassium, chloride, bicarb, and glucose. Over the first day the patient received 150ml/hr of D10.45NS without K and subsequently had marked improvement of her neurologic status. She complained only of abdominal pain. Endocrinology visited in the patient and her family for discussion of her new diagnosis and next steps.    On 12/24 she had worsening AKI for which nephrology was consulted and evaluated the patient. CK slightly elevated. Renal U/S showed borderline enlarged kidneys and reactive right urothelial thickening. Urinalysis showed bacteria, 26 WBC, and blood, and was sent for culture. Urine culture 12/24 with pan-sensitive E. Coli. Asymptomatic. Indwelling cath from early AM 12/24 - AM 12/25. Oliguric from AKI. Transitioned from Ceftriaxone to Keflex 12/26 for a total of 7 days of antibiotics. Potassium was added back into her fluids given her degree of hypokalemia. The patient was transitioned to SubQ insulin and given a general diet. Her fluids are kept on due to her degree of dehydration, and RFP were obtained q8h overnight into 12/25.    On 12/25, IVF rate was decreased to avoid potentional fluid overload. RFP was rechecked and showed continued worsening kidney function. Pt was given lasix x2 due to decreased urine output.    On 12/26, morning RFP continued to show decreased kidney function. By this point patient had remained stable and DKA had nearly resolved. Given worsening kidney function patient was transferred out of the ICU to the Nephrology service for further management. Did have hypocalcemia and was started on calcium carbonate TID, and hypokalemia and this was repleted.   Creatinine continued to trend upward, 5.56 on 12/27. S/p aggressive fluid resuscitation, now euvolemic on exam. Oliguria, UOP 0.6 ml/kg/hr and hypertensive with systolics in the mid 120s and diastolics in the high 80s. Associated electrolyte abnormalities. Hemodialysis with renal biopsy considered, but creatinine did decrease to 4.91 on 12/29 with increased UOP to 2.5ml/kg/hr. Due to improvement patient was felt to be stable for discharge home with close monitoring of RFP and daily weights. Diabetes education was performed and parents were agreeable to the plan.
Age: 9.0
Sex: F
Vaccine: COVID19
Symptoms: Blood creatine phosphokinase increased, Blood culture, Blood glucose, Blood potassium, COVID-19
Clinical narrative: Discharge Provider:   Primary Care Physician at Discharge:  Admission Date: 12/22/2022  Discharge Date: 12/29/2022 COVID positive date: 12/22/2022 DKA, type 1, not at goal [E10.10] AKI (acute kidney injury) [N17.9]   HOSPITAL COURSE: Pt. is a 10-year-old female presenting with severe DKA from new onset T1DM, possibly triggered by COVID-19 infection. She was obtunded when she presented to the outside hospital and was improved, but somnolent, upon arrival to our ICU on 12/22. She did receive mannitol x1 for concern of cerebral edema. Insulin was started at 0.1 units/kg/hr and her fluids were adjusted based on her potassium, chloride, bicarb, and glucose. Over the first day the patient received 150ml/hr of D10.45NS without K and subsequently had marked improvement of her neurologic status. She complained only of abdominal pain. Endocrinology visited in the patient and her family for discussion of her new diagnosis and next steps.    On 12/24 she had worsening AKI for which nephrology was consulted and evaluated the patient. CK slightly elevated. Renal U/S showed borderline enlarged kidneys and reactive right urothelial thickening. Urinalysis showed bacteria, 26 WBC, and blood, and was sent for culture. Urine culture 12/24 with pan-sensitive E. Coli. Asymptomatic. Indwelling cath from early AM 12/24 - AM 12/25. Oliguric from AKI. Transitioned from Ceftriaxone to Keflex 12/26 for a total of 7 days of antibiotics. Potassium was added back into her fluids given her degree of hypokalemia. The patient was transitioned to SubQ insulin and given a general diet. Her fluids are kept on due to her degree of dehydration, and RFP were obtained q8h overnight into 12/25.    On 12/25, IVF rate was decreased to avoid potentional fluid overload. RFP was rechecked and showed continued worsening kidney function. Pt was given lasix x2 due to decreased urine output.    On 12/26, morning RFP continued to show decreased kidney function. By this point patient had remained stable and DKA had nearly resolved. Given worsening kidney function patient was transferred out of the ICU to the Nephrology service for further management. Did have hypocalcemia and was started on calcium carbonate TID, and hypokalemia and this was repleted.   Creatinine continued to trend upward, 5.56 on 12/27. S/p aggressive fluid resuscitation, now euvolemic on exam. Oliguria, UOP 0.6 ml/kg/hr and hypertensive with systolics in the mid 120s and diastolics in the high 80s. Associated electrolyte abnormalities. Hemodialysis with renal biopsy considered, but creatinine did decrease to 4.91 on 12/29 with increased UOP to 2.5ml/kg/hr. Due to improvement patient was felt to be stable for discharge home with close monitoring of RFP and daily weights. Diabetes education was performed and parents were agreeable to the plan.
Age: 9.0
Sex: F
Vaccine: COVID19
Symptoms: Catheter placement, Condition aggravated, Culture urine positive, Dehydration, Diabetic ketoacidosis
Clinical narrative: Discharge Provider:   Primary Care Physician at Discharge:  Admission Date: 12/22/2022  Discharge Date: 12/29/2022 COVID positive date: 12/22/2022 DKA, type 1, not at goal [E10.10] AKI (acute kidney injury) [N17.9]   HOSPITAL COURSE: Pt. is a 10-year-old female presenting with severe DKA from new onset T1DM, possibly triggered by COVID-19 infection. She was obtunded when she presented to the outside hospital and was improved, but somnolent, upon arrival to our ICU on 12/22. She did receive mannitol x1 for concern of cerebral edema. Insulin was started at 0.1 units/kg/hr and her fluids were adjusted based on her potassium, chloride, bicarb, and glucose. Over the first day the patient received 150ml/hr of D10.45NS without K and subsequently had marked improvement of her neurologic status. She complained only of abdominal pain. Endocrinology visited in the patient and her family for discussion of her new diagnosis and next steps.    On 12/24 she had worsening AKI for which nephrology was consulted and evaluated the patient. CK slightly elevated. Renal U/S showed borderline enlarged kidneys and reactive right urothelial thickening. Urinalysis showed bacteria, 26 WBC, and blood, and was sent for culture. Urine culture 12/24 with pan-sensitive E. Coli. Asymptomatic. Indwelling cath from early AM 12/24 - AM 12/25. Oliguric from AKI. Transitioned from Ceftriaxone to Keflex 12/26 for a total of 7 days of antibiotics. Potassium was added back into her fluids given her degree of hypokalemia. The patient was transitioned to SubQ insulin and given a general diet. Her fluids are kept on due to her degree of dehydration, and RFP were obtained q8h overnight into 12/25.    On 12/25, IVF rate was decreased to avoid potentional fluid overload. RFP was rechecked and showed continued worsening kidney function. Pt was given lasix x2 due to decreased urine output.    On 12/26, morning RFP continued to show decreased kidney function. By this point patient had remained stable and DKA had nearly resolved. Given worsening kidney function patient was transferred out of the ICU to the Nephrology service for further management. Did have hypocalcemia and was started on calcium carbonate TID, and hypokalemia and this was repleted.   Creatinine continued to trend upward, 5.56 on 12/27. S/p aggressive fluid resuscitation, now euvolemic on exam. Oliguria, UOP 0.6 ml/kg/hr and hypertensive with systolics in the mid 120s and diastolics in the high 80s. Associated electrolyte abnormalities. Hemodialysis with renal biopsy considered, but creatinine did decrease to 4.91 on 12/29 with increased UOP to 2.5ml/kg/hr. Due to improvement patient was felt to be stable for discharge home with close monitoring of RFP and daily weights. Diabetes education was performed and parents were agreeable to the plan.
Age: 9.0
Sex: F
Vaccine: COVID19
Symptoms: Electrolyte imbalance, Escherichia test positive, Hypertension, Hypocalcaemia, Hypokalaemia
Clinical narrative: Discharge Provider:   Primary Care Physician at Discharge:  Admission Date: 12/22/2022  Discharge Date: 12/29/2022 COVID positive date: 12/22/2022 DKA, type 1, not at goal [E10.10] AKI (acute kidney injury) [N17.9]   HOSPITAL COURSE: Pt. is a 10-year-old female presenting with severe DKA from new onset T1DM, possibly triggered by COVID-19 infection. She was obtunded when she presented to the outside hospital and was improved, but somnolent, upon arrival to our ICU on 12/22. She did receive mannitol x1 for concern of cerebral edema. Insulin was started at 0.1 units/kg/hr and her fluids were adjusted based on her potassium, chloride, bicarb, and glucose. Over the first day the patient received 150ml/hr of D10.45NS without K and subsequently had marked improvement of her neurologic status. She complained only of abdominal pain. Endocrinology visited in the patient and her family for discussion of her new diagnosis and next steps.    On 12/24 she had worsening AKI for which nephrology was consulted and evaluated the patient. CK slightly elevated. Renal U/S showed borderline enlarged kidneys and reactive right urothelial thickening. Urinalysis showed bacteria, 26 WBC, and blood, and was sent for culture. Urine culture 12/24 with pan-sensitive E. Coli. Asymptomatic. Indwelling cath from early AM 12/24 - AM 12/25. Oliguric from AKI. Transitioned from Ceftriaxone to Keflex 12/26 for a total of 7 days of antibiotics. Potassium was added back into her fluids given her degree of hypokalemia. The patient was transitioned to SubQ insulin and given a general diet. Her fluids are kept on due to her degree of dehydration, and RFP were obtained q8h overnight into 12/25.    On 12/25, IVF rate was decreased to avoid potentional fluid overload. RFP was rechecked and showed continued worsening kidney function. Pt was given lasix x2 due to decreased urine output.    On 12/26, morning RFP continued to show decreased kidney function. By this point patient had remained stable and DKA had nearly resolved. Given worsening kidney function patient was transferred out of the ICU to the Nephrology service for further management. Did have hypocalcemia and was started on calcium carbonate TID, and hypokalemia and this was repleted.   Creatinine continued to trend upward, 5.56 on 12/27. S/p aggressive fluid resuscitation, now euvolemic on exam. Oliguria, UOP 0.6 ml/kg/hr and hypertensive with systolics in the mid 120s and diastolics in the high 80s. Associated electrolyte abnormalities. Hemodialysis with renal biopsy considered, but creatinine did decrease to 4.91 on 12/29 with increased UOP to 2.5ml/kg/hr. Due to improvement patient was felt to be stable for discharge home with close monitoring of RFP and daily weights. Diabetes education was performed and parents were agreeable to the plan.
Age: 9.0
Sex: F
Vaccine: COVID19
Symptoms: Intensive care, Kidney enlargement, Oliguria, Renal impairment, SARS-CoV-2 test positive
Clinical narrative: Discharge Provider:   Primary Care Physician at Discharge:  Admission Date: 12/22/2022  Discharge Date: 12/29/2022 COVID positive date: 12/22/2022 DKA, type 1, not at goal [E10.10] AKI (acute kidney injury) [N17.9]   HOSPITAL COURSE: Pt. is a 10-year-old female presenting with severe DKA from new onset T1DM, possibly triggered by COVID-19 infection. She was obtunded when she presented to the outside hospital and was improved, but somnolent, upon arrival to our ICU on 12/22. She did receive mannitol x1 for concern of cerebral edema. Insulin was started at 0.1 units/kg/hr and her fluids were adjusted based on her potassium, chloride, bicarb, and glucose. Over the first day the patient received 150ml/hr of D10.45NS without K and subsequently had marked improvement of her neurologic status. She complained only of abdominal pain. Endocrinology visited in the patient and her family for discussion of her new diagnosis and next steps.    On 12/24 she had worsening AKI for which nephrology was consulted and evaluated the patient. CK slightly elevated. Renal U/S showed borderline enlarged kidneys and reactive right urothelial thickening. Urinalysis showed bacteria, 26 WBC, and blood, and was sent for culture. Urine culture 12/24 with pan-sensitive E. Coli. Asymptomatic. Indwelling cath from early AM 12/24 - AM 12/25. Oliguric from AKI. Transitioned from Ceftriaxone to Keflex 12/26 for a total of 7 days of antibiotics. Potassium was added back into her fluids given her degree of hypokalemia. The patient was transitioned to SubQ insulin and given a general diet. Her fluids are kept on due to her degree of dehydration, and RFP were obtained q8h overnight into 12/25.    On 12/25, IVF rate was decreased to avoid potentional fluid overload. RFP was rechecked and showed continued worsening kidney function. Pt was given lasix x2 due to decreased urine output.    On 12/26, morning RFP continued to show decreased kidney function. By this point patient had remained stable and DKA had nearly resolved. Given worsening kidney function patient was transferred out of the ICU to the Nephrology service for further management. Did have hypocalcemia and was started on calcium carbonate TID, and hypokalemia and this was repleted.   Creatinine continued to trend upward, 5.56 on 12/27. S/p aggressive fluid resuscitation, now euvolemic on exam. Oliguria, UOP 0.6 ml/kg/hr and hypertensive with systolics in the mid 120s and diastolics in the high 80s. Associated electrolyte abnormalities. Hemodialysis with renal biopsy considered, but creatinine did decrease to 4.91 on 12/29 with increased UOP to 2.5ml/kg/hr. Due to improvement patient was felt to be stable for discharge home with close monitoring of RFP and daily weights. Diabetes education was performed and parents were agreeable to the plan.
Age: 9.0
Sex: F
Vaccine: COVID19
Symptoms: Somnolence, Type 1 diabetes mellitus, Ultrasound kidney abnormal, Urine analysis abnormal, Urine output decreased
Clinical narrative: Discharge Provider:   Primary Care Physician at Discharge:  Admission Date: 12/22/2022  Discharge Date: 12/29/2022 COVID positive date: 12/22/2022 DKA, type 1, not at goal [E10.10] AKI (acute kidney injury) [N17.9]   HOSPITAL COURSE: Pt. is a 10-year-old female presenting with severe DKA from new onset T1DM, possibly triggered by COVID-19 infection. She was obtunded when she presented to the outside hospital and was improved, but somnolent, upon arrival to our ICU on 12/22. She did receive mannitol x1 for concern of cerebral edema. Insulin was started at 0.1 units/kg/hr and her fluids were adjusted based on her potassium, chloride, bicarb, and glucose. Over the first day the patient received 150ml/hr of D10.45NS without K and subsequently had marked improvement of her neurologic status. She complained only of abdominal pain. Endocrinology visited in the patient and her family for discussion of her new diagnosis and next steps.    On 12/24 she had worsening AKI for which nephrology was consulted and evaluated the patient. CK slightly elevated. Renal U/S showed borderline enlarged kidneys and reactive right urothelial thickening. Urinalysis showed bacteria, 26 WBC, and blood, and was sent for culture. Urine culture 12/24 with pan-sensitive E. Coli. Asymptomatic. Indwelling cath from early AM 12/24 - AM 12/25. Oliguric from AKI. Transitioned from Ceftriaxone to Keflex 12/26 for a total of 7 days of antibiotics. Potassium was added back into her fluids given her degree of hypokalemia. The patient was transitioned to SubQ insulin and given a general diet. Her fluids are kept on due to her degree of dehydration, and RFP were obtained q8h overnight into 12/25.    On 12/25, IVF rate was decreased to avoid potentional fluid overload. RFP was rechecked and showed continued worsening kidney function. Pt was given lasix x2 due to decreased urine output.    On 12/26, morning RFP continued to show decreased kidney function. By this point patient had remained stable and DKA had nearly resolved. Given worsening kidney function patient was transferred out of the ICU to the Nephrology service for further management. Did have hypocalcemia and was started on calcium carbonate TID, and hypokalemia and this was repleted.   Creatinine continued to trend upward, 5.56 on 12/27. S/p aggressive fluid resuscitation, now euvolemic on exam. Oliguria, UOP 0.6 ml/kg/hr and hypertensive with systolics in the mid 120s and diastolics in the high 80s. Associated electrolyte abnormalities. Hemodialysis with renal biopsy considered, but creatinine did decrease to 4.91 on 12/29 with increased UOP to 2.5ml/kg/hr. Due to improvement patient was felt to be stable for discharge home with close monitoring of RFP and daily weights. Diabetes education was performed and parents were agreeable to the plan.
Age: 9.0
Sex: F
Vaccine: COVID19
Symptoms: White blood cell count increased
Clinical narrative: Discharge Provider:   Primary Care Physician at Discharge:  Admission Date: 12/22/2022  Discharge Date: 12/29/2022 COVID positive date: 12/22/2022 DKA, type 1, not at goal [E10.10] AKI (acute kidney injury) [N17.9]   HOSPITAL COURSE: Pt. is a 10-year-old female presenting with severe DKA from new onset T1DM, possibly triggered by COVID-19 infection. She was obtunded when she presented to the outside hospital and was improved, but somnolent, upon arrival to our ICU on 12/22. She did receive mannitol x1 for concern of cerebral edema. Insulin was started at 0.1 units/kg/hr and her fluids were adjusted based on her potassium, chloride, bicarb, and glucose. Over the first day the patient received 150ml/hr of D10.45NS without K and subsequently had marked improvement of her neurologic status. She complained only of abdominal pain. Endocrinology visited in the patient and her family for discussion of her new diagnosis and next steps.    On 12/24 she had worsening AKI for which nephrology was consulted and evaluated the patient. CK slightly elevated. Renal U/S showed borderline enlarged kidneys and reactive right urothelial thickening. Urinalysis showed bacteria, 26 WBC, and blood, and was sent for culture. Urine culture 12/24 with pan-sensitive E. Coli. Asymptomatic. Indwelling cath from early AM 12/24 - AM 12/25. Oliguric from AKI. Transitioned from Ceftriaxone to Keflex 12/26 for a total of 7 days of antibiotics. Potassium was added back into her fluids given her degree of hypokalemia. The patient was transitioned to SubQ insulin and given a general diet. Her fluids are kept on due to her degree of dehydration, and RFP were obtained q8h overnight into 12/25.    On 12/25, IVF rate was decreased to avoid potentional fluid overload. RFP was rechecked and showed continued worsening kidney function. Pt was given lasix x2 due to decreased urine output.    On 12/26, morning RFP continued to show decreased kidney function. By this point patient had remained stable and DKA had nearly resolved. Given worsening kidney function patient was transferred out of the ICU to the Nephrology service for further management. Did have hypocalcemia and was started on calcium carbonate TID, and hypokalemia and this was repleted.   Creatinine continued to trend upward, 5.56 on 12/27. S/p aggressive fluid resuscitation, now euvolemic on exam. Oliguria, UOP 0.6 ml/kg/hr and hypertensive with systolics in the mid 120s and diastolics in the high 80s. Associated electrolyte abnormalities. Hemodialysis with renal biopsy considered, but creatinine did decrease to 4.91 on 12/29 with increased UOP to 2.5ml/kg/hr. Due to improvement patient was felt to be stable for discharge home with close monitoring of RFP and daily weights. Diabetes education was performed and parents were agreeable to the plan.
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Anticoagulant therapy, Atrial fibrillation, Blood test normal, Cardiac pacemaker insertion, Cardioversion
Clinical narrative: 4/6/22 I started hyperventilating, had trouble getting my breath. An ambulance was called, and I was taken to the hospital and was admitted. I was diagnosed with AFIB. I was treated for that. A cardioversion was done while I was in the hospital. After 18 hours, I went back out of rhythm again.  Then I had a pacemaker placed and was given medicines. The medications I was prescribed amiodarone, baby aspirin, ENTRESTO, FARXIGA, LASIX, metoprolol, XARELTO. I added vitamin C to the other vitamins and supplements I was already on. I was taken off the lovastatin and put back on. I have my pacemaker checked and have had my AFIB in control. I went back to the hospital the first of June, 2022 for a procedure, an ablation, they could not do and found a blood clot. Now, they are treating the blood clot with medication.
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Chest X-ray normal, Dyspnoea, Electrocardiogram abnormal, Hyperventilation, Thrombosis
Clinical narrative: 4/6/22 I started hyperventilating, had trouble getting my breath. An ambulance was called, and I was taken to the hospital and was admitted. I was diagnosed with AFIB. I was treated for that. A cardioversion was done while I was in the hospital. After 18 hours, I went back out of rhythm again.  Then I had a pacemaker placed and was given medicines. The medications I was prescribed amiodarone, baby aspirin, ENTRESTO, FARXIGA, LASIX, metoprolol, XARELTO. I added vitamin C to the other vitamins and supplements I was already on. I was taken off the lovastatin and put back on. I have my pacemaker checked and have had my AFIB in control. I went back to the hospital the first of June, 2022 for a procedure, an ablation, they could not do and found a blood clot. Now, they are treating the blood clot with medication.
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: X-ray gastrointestinal tract abnormal
Clinical narrative: 4/6/22 I started hyperventilating, had trouble getting my breath. An ambulance was called, and I was taken to the hospital and was admitted. I was diagnosed with AFIB. I was treated for that. A cardioversion was done while I was in the hospital. After 18 hours, I went back out of rhythm again.  Then I had a pacemaker placed and was given medicines. The medications I was prescribed amiodarone, baby aspirin, ENTRESTO, FARXIGA, LASIX, metoprolol, XARELTO. I added vitamin C to the other vitamins and supplements I was already on. I was taken off the lovastatin and put back on. I have my pacemaker checked and have had my AFIB in control. I went back to the hospital the first of June, 2022 for a procedure, an ablation, they could not do and found a blood clot. Now, they are treating the blood clot with medication.
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, COVID-19, Death, SARS-CoV-2 test positive
Clinical narrative: Admitted 12/21/2022 to a local Medical Center for acute hypoxemic respiratory failure COVID positive 12/21/2022 Date of death 12/26/2022
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Arthropathy, Asthenia, Blood pressure increased, COVID-19, Cerebral atrophy
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: NP  Admission Date: 12/19/2022 Discharge Date: 12/30/2022 COVID positive date: 12/19/2022  HOSPITAL COURSE: Patient is a 75-year-old female with a past medical history of a CVA with residual left-sided weakness, hypertension, hyperlipidemia who presented with weakness and falls.  Patient's family stated that she had been falling quite frequently and that her knees would give out.  She did have chronic left-sided weakness which was greater in the upper extremity and prior to this admission was able to ambulate.   In the Emergency Department, she was found to be positive for COVID-19.  She was afebrile and not hypoxic.  Labs were within normal limits. She had pelvic x-ray done 12/18 which showed degenerative changes without any acute pathology.  Lumbar spine x-ray done 12/19 that showed osteopenia, grade 1 anterolisthesis of L4, no compression fracture.  X-ray of the left tib-fib and left foot did not reveal any acute fracture.   CT cervical spine did not reveal any acute fracture or dislocation.  CT thoracic spine also did not reveal any acute pathology. Neurology was consulted and their recommendation was for MRI of the cervical, lumbar spine and brain.  MRI lumbar spine and cervical spine showed degenerative changes without any acute significant findings.  MRI of the brain was completed and did not reveal any acute intracranial abnormality and showed findings of chronic small-vessel ischemic disease, generalized pain atrophy, encephalomalacia and multiple foci of old appearing lacunar infarcts. Neurology did not recommend any further workup and signed off.  She was continued on Plavix and statin for her prior CVA.   Patient was not hypoxic and therefore was not placed on any treatments for COVID-19.  Her blood pressures were found to be elevated and she her doses of Cozaar and Coreg were increased to 12.5 mg and 50 mg, respectively.  She was seen by PT and OT and recommendation was for acute inpatient rehabilitation. However PM&R evaluated patient and felt she was a candidate for subacute rehab and not acute rehab.   She was ultimately discharged for rehab on 12/30/2022.  She should follow-up with her PCP in 1 week.
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Cerebral small vessel ischaemic disease, Computerised tomogram normal, Condition aggravated, Encephalomalacia, Fall
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: NP  Admission Date: 12/19/2022 Discharge Date: 12/30/2022 COVID positive date: 12/19/2022  HOSPITAL COURSE: Patient is a 75-year-old female with a past medical history of a CVA with residual left-sided weakness, hypertension, hyperlipidemia who presented with weakness and falls.  Patient's family stated that she had been falling quite frequently and that her knees would give out.  She did have chronic left-sided weakness which was greater in the upper extremity and prior to this admission was able to ambulate.   In the Emergency Department, she was found to be positive for COVID-19.  She was afebrile and not hypoxic.  Labs were within normal limits. She had pelvic x-ray done 12/18 which showed degenerative changes without any acute pathology.  Lumbar spine x-ray done 12/19 that showed osteopenia, grade 1 anterolisthesis of L4, no compression fracture.  X-ray of the left tib-fib and left foot did not reveal any acute fracture.   CT cervical spine did not reveal any acute fracture or dislocation.  CT thoracic spine also did not reveal any acute pathology. Neurology was consulted and their recommendation was for MRI of the cervical, lumbar spine and brain.  MRI lumbar spine and cervical spine showed degenerative changes without any acute significant findings.  MRI of the brain was completed and did not reveal any acute intracranial abnormality and showed findings of chronic small-vessel ischemic disease, generalized pain atrophy, encephalomalacia and multiple foci of old appearing lacunar infarcts. Neurology did not recommend any further workup and signed off.  She was continued on Plavix and statin for her prior CVA.   Patient was not hypoxic and therefore was not placed on any treatments for COVID-19.  Her blood pressures were found to be elevated and she her doses of Cozaar and Coreg were increased to 12.5 mg and 50 mg, respectively.  She was seen by PT and OT and recommendation was for acute inpatient rehabilitation. However PM&R evaluated patient and felt she was a candidate for subacute rehab and not acute rehab.   She was ultimately discharged for rehab on 12/30/2022.  She should follow-up with her PCP in 1 week.
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Laboratory test normal, Lacunar infarction, Magnetic resonance imaging head abnormal, Magnetic resonance imaging spinal abnormal, Myelopathy
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: NP  Admission Date: 12/19/2022 Discharge Date: 12/30/2022 COVID positive date: 12/19/2022  HOSPITAL COURSE: Patient is a 75-year-old female with a past medical history of a CVA with residual left-sided weakness, hypertension, hyperlipidemia who presented with weakness and falls.  Patient's family stated that she had been falling quite frequently and that her knees would give out.  She did have chronic left-sided weakness which was greater in the upper extremity and prior to this admission was able to ambulate.   In the Emergency Department, she was found to be positive for COVID-19.  She was afebrile and not hypoxic.  Labs were within normal limits. She had pelvic x-ray done 12/18 which showed degenerative changes without any acute pathology.  Lumbar spine x-ray done 12/19 that showed osteopenia, grade 1 anterolisthesis of L4, no compression fracture.  X-ray of the left tib-fib and left foot did not reveal any acute fracture.   CT cervical spine did not reveal any acute fracture or dislocation.  CT thoracic spine also did not reveal any acute pathology. Neurology was consulted and their recommendation was for MRI of the cervical, lumbar spine and brain.  MRI lumbar spine and cervical spine showed degenerative changes without any acute significant findings.  MRI of the brain was completed and did not reveal any acute intracranial abnormality and showed findings of chronic small-vessel ischemic disease, generalized pain atrophy, encephalomalacia and multiple foci of old appearing lacunar infarcts. Neurology did not recommend any further workup and signed off.  She was continued on Plavix and statin for her prior CVA.   Patient was not hypoxic and therefore was not placed on any treatments for COVID-19.  Her blood pressures were found to be elevated and she her doses of Cozaar and Coreg were increased to 12.5 mg and 50 mg, respectively.  She was seen by PT and OT and recommendation was for acute inpatient rehabilitation. However PM&R evaluated patient and felt she was a candidate for subacute rehab and not acute rehab.   She was ultimately discharged for rehab on 12/30/2022.  She should follow-up with her PCP in 1 week.