chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Urinary tract disorder, Vertebral artery stenosis, Vitamin B12 normal
Clinical narrative: Patient is a 76 y.o. male who presented from home on 9/14/2023 with unsteady gait, tremors and urinary symptoms. Tested positive for COVID-19.  Behavioral medicine consulted due to patient's history of bipolar disorder for titration of medications.  Patient was taken out of isolation for COVID.   Gait instability - Etiology unclear. Likely weakness and decompensation from COVID-19. Unlikely cardiac in nature due to normal troponin.  Unlikely stroke though unable to completely rule out as cannot have MRI - Patient uses cane and walker at baseline, since 2011 - Neuro exam unremarkable. Valproic acid level elevated but still within therapeutic range. - CT angio of the head and neck with no acute intracranial abnormality. Atherosclerosis present with moderate stenosis of the L vertebral artery, stenosis of the proximal cervical ICAs b/l. Orthostatics negative. -B12 normal -Unable to undergo MRI due to his cardiac device -Repeat CT negative; will monitor for any evidence of gait instability -He was clinically improving and ambulating better with therapy but then on 9/19 early morning had a fall - got up on own and tripped over bipap tubing - repeat ct stable -Imaging of lumbar spine 9/25 negative for any displacement of previous surgical hardware or acute fractures.   Depression Bipolar disorder - Recently hospitalization for manic episode and meds adjusted. Per wife, patient sleeps often and is fatigued due to depression.  -Also significantly improved on discharge. - Was started on Depakote for bipolar disorder 3 weeks ago. Continue inpatient; however dose reduced due to valproic acid level.  Significantly improved mood. -Dose of Depakote reduced from 2000mg to 1500mg and started on Wellbutrin 150 daily per behavioral medicine recs on discharge.   COVID-19 - Patient vaccinated with Moderna + booster. - Symptom onset day before admission. Patient satting well on room air. - ID consult for possible Paxlovid use; started on Paxlovid 9/15 and course completed  - Given one-time Lasix on 9/16/23; lung exam much improved now and off O2   Thrombocytopenia - Baseline PLT count ~200. 98 upon admission. Likely due to COVID-19 infection. - LDH is normal, haptoglobin is normal - improved to nl range now xysmal atrial fibrillation - On home Xarelto 20 mg.  Rate controlled in NSR - Changed to Eliquis while patient is on Paxlovid, now back on Xarelto.   SA node dysfunction w/ pacemaker - Pacemaker battery last replaced on 9/4. Base pace rate is 45 bpm. - Continue to monitor via telemetry.   Chronic kidney disease - Baseline Cr between ~1.5. Cr 1.60 upon admission.  - Continue to monitor.  - Was given one-time dose of Lasix on 9/16 given his congestion for dry lung strategy, tolerated this well   HTN -On home Norvasc 5 mg, Carvedilol 25 BID at home, Losartan 50 mg. -BP controlled without Coreg, patient was bradycardic to 50-55 HR without Coreg. -continue home meds and monitor. Stop Carvedilol due to bradycardia.
Age: 59.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: VACCINE WAS  STORED IN AN UNAPPROVED STORAGE UNIT
Age: 48.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: THE PATIENT WAS INJECTED WITH AN EXPIRED DOSE.  THE VIAL WAS ORIGINALLY OPENED ON SATURDAY 10/14/2023.  THE PATIENT WAS INJECTED ON MONDAY 10/16/2023. THE PATIENT WAS INJECTED WITH ANOTHER DOSE FROM A FRESH VIAL.
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Atelectasis, Bacterial disease carrier, Bacteriuria
Clinical narrative: Patient is a 73 y.o. male patient of MD with history of hypertension, stroke, and diabetes mellitus type II who presented to Hospital with shortness of breath.   Acute Hypoxemic Respiratory Failure Covid-19 Virus Infection Date of onset of symptoms: 9/15/2023 Symptoms present on admission: dyspnea, fever, tachypnea Date of covid positive test: 9/18/2023 Vaccination status: vaccinated Imaging: Chest x-ray with bilateral atelectasis Oxygen requirements on admission: 4 L Current oxygen requirements: RA Medical therapy: steroids, remdesivir; will discontinue both as he is now stable on RA Consultants following: None Anticipated special isolation end date: 9/25/2023   Severe Sepsis Lactic Acidosis 2/2 COVID 19 infection Initial lactate was 2.2, improved to 1.8 with IVF Low suspicion for concomitant bacterial pneumonia Urine sample was collected off of chronic indwelling SPC Blood cx x 2 with NGTD Will stop CTX and azithromycin at this time Management of COVID as above   Acute on Chronic Renal Failure Cr 3.22 on arrival; baseline is 1.8-2 Received IVF Renal US with asymmetric kidneys but no hydronephrosis Cr peaked at 3.5; improving to 3 Cr stabilized, suspect he has ATN due to AKI Repeat BMP in 1 week Outpatient nephro follow-up  Elevated troponin Initial troponin 106, repeat 101 EKG without acute ischemic changes Suspect elevation due to demand ischemia with hypoxia, concurrent infection Continue to monitor on telemetry   Neurogenic Bladder Bacteriuria Pt with indwelling SPC catheter, last exchange was on 8/24 per family UA grossly contaminated Clinically low suspicion for UTI at this time Urine cx positive for pseudomonas, likely due to colonization Urology performed SPC exchange on 9/20 No antibiotics indicated   Positive Blood Culture 2/2 blood cx with growth of coag neg staph 1/2 blood cx with growth of MSSA Repeat blood cx 9/20 with NGTD Suspect positive cultures are result of contaminant Given presence of S. Aureus however, will consult ID He has not had any fevers or evidence of clinical decompensation Discussed with ID, will plan for doxycyline for 7d   History of CVA with residual right-sided hemiplegia Chronic aphasia Dysphagia In wheelchair at baseline, lives with family at home Known chronic dysphagia, pt refuses to eat modified diet and will not work with SLP Family agreeable to regular diet at this time   Diabetes mellitus type 2 Continue home basal + SSI
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Bladder catheterisation, Blood creatinine increased, Blood culture positive, Blood lactic acid, COVID-19
Clinical narrative: Patient is a 73 y.o. male patient of MD with history of hypertension, stroke, and diabetes mellitus type II who presented to Hospital with shortness of breath.   Acute Hypoxemic Respiratory Failure Covid-19 Virus Infection Date of onset of symptoms: 9/15/2023 Symptoms present on admission: dyspnea, fever, tachypnea Date of covid positive test: 9/18/2023 Vaccination status: vaccinated Imaging: Chest x-ray with bilateral atelectasis Oxygen requirements on admission: 4 L Current oxygen requirements: RA Medical therapy: steroids, remdesivir; will discontinue both as he is now stable on RA Consultants following: None Anticipated special isolation end date: 9/25/2023   Severe Sepsis Lactic Acidosis 2/2 COVID 19 infection Initial lactate was 2.2, improved to 1.8 with IVF Low suspicion for concomitant bacterial pneumonia Urine sample was collected off of chronic indwelling SPC Blood cx x 2 with NGTD Will stop CTX and azithromycin at this time Management of COVID as above   Acute on Chronic Renal Failure Cr 3.22 on arrival; baseline is 1.8-2 Received IVF Renal US with asymmetric kidneys but no hydronephrosis Cr peaked at 3.5; improving to 3 Cr stabilized, suspect he has ATN due to AKI Repeat BMP in 1 week Outpatient nephro follow-up  Elevated troponin Initial troponin 106, repeat 101 EKG without acute ischemic changes Suspect elevation due to demand ischemia with hypoxia, concurrent infection Continue to monitor on telemetry   Neurogenic Bladder Bacteriuria Pt with indwelling SPC catheter, last exchange was on 8/24 per family UA grossly contaminated Clinically low suspicion for UTI at this time Urine cx positive for pseudomonas, likely due to colonization Urology performed SPC exchange on 9/20 No antibiotics indicated   Positive Blood Culture 2/2 blood cx with growth of coag neg staph 1/2 blood cx with growth of MSSA Repeat blood cx 9/20 with NGTD Suspect positive cultures are result of contaminant Given presence of S. Aureus however, will consult ID He has not had any fevers or evidence of clinical decompensation Discussed with ID, will plan for doxycyline for 7d   History of CVA with residual right-sided hemiplegia Chronic aphasia Dysphagia In wheelchair at baseline, lives with family at home Known chronic dysphagia, pt refuses to eat modified diet and will not work with SLP Family agreeable to regular diet at this time   Diabetes mellitus type 2 Continue home basal + SSI
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Chest X-ray abnormal, Dyspnoea, Electrocardiogram normal, Lactic acidosis, Myocardial ischaemia
Clinical narrative: Patient is a 73 y.o. male patient of MD with history of hypertension, stroke, and diabetes mellitus type II who presented to Hospital with shortness of breath.   Acute Hypoxemic Respiratory Failure Covid-19 Virus Infection Date of onset of symptoms: 9/15/2023 Symptoms present on admission: dyspnea, fever, tachypnea Date of covid positive test: 9/18/2023 Vaccination status: vaccinated Imaging: Chest x-ray with bilateral atelectasis Oxygen requirements on admission: 4 L Current oxygen requirements: RA Medical therapy: steroids, remdesivir; will discontinue both as he is now stable on RA Consultants following: None Anticipated special isolation end date: 9/25/2023   Severe Sepsis Lactic Acidosis 2/2 COVID 19 infection Initial lactate was 2.2, improved to 1.8 with IVF Low suspicion for concomitant bacterial pneumonia Urine sample was collected off of chronic indwelling SPC Blood cx x 2 with NGTD Will stop CTX and azithromycin at this time Management of COVID as above   Acute on Chronic Renal Failure Cr 3.22 on arrival; baseline is 1.8-2 Received IVF Renal US with asymmetric kidneys but no hydronephrosis Cr peaked at 3.5; improving to 3 Cr stabilized, suspect he has ATN due to AKI Repeat BMP in 1 week Outpatient nephro follow-up  Elevated troponin Initial troponin 106, repeat 101 EKG without acute ischemic changes Suspect elevation due to demand ischemia with hypoxia, concurrent infection Continue to monitor on telemetry   Neurogenic Bladder Bacteriuria Pt with indwelling SPC catheter, last exchange was on 8/24 per family UA grossly contaminated Clinically low suspicion for UTI at this time Urine cx positive for pseudomonas, likely due to colonization Urology performed SPC exchange on 9/20 No antibiotics indicated   Positive Blood Culture 2/2 blood cx with growth of coag neg staph 1/2 blood cx with growth of MSSA Repeat blood cx 9/20 with NGTD Suspect positive cultures are result of contaminant Given presence of S. Aureus however, will consult ID He has not had any fevers or evidence of clinical decompensation Discussed with ID, will plan for doxycyline for 7d   History of CVA with residual right-sided hemiplegia Chronic aphasia Dysphagia In wheelchair at baseline, lives with family at home Known chronic dysphagia, pt refuses to eat modified diet and will not work with SLP Family agreeable to regular diet at this time   Diabetes mellitus type 2 Continue home basal + SSI
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Neurogenic bladder, Pyrexia, Renal tubular necrosis, SARS-CoV-2 test positive, Sepsis
Clinical narrative: Patient is a 73 y.o. male patient of MD with history of hypertension, stroke, and diabetes mellitus type II who presented to Hospital with shortness of breath.   Acute Hypoxemic Respiratory Failure Covid-19 Virus Infection Date of onset of symptoms: 9/15/2023 Symptoms present on admission: dyspnea, fever, tachypnea Date of covid positive test: 9/18/2023 Vaccination status: vaccinated Imaging: Chest x-ray with bilateral atelectasis Oxygen requirements on admission: 4 L Current oxygen requirements: RA Medical therapy: steroids, remdesivir; will discontinue both as he is now stable on RA Consultants following: None Anticipated special isolation end date: 9/25/2023   Severe Sepsis Lactic Acidosis 2/2 COVID 19 infection Initial lactate was 2.2, improved to 1.8 with IVF Low suspicion for concomitant bacterial pneumonia Urine sample was collected off of chronic indwelling SPC Blood cx x 2 with NGTD Will stop CTX and azithromycin at this time Management of COVID as above   Acute on Chronic Renal Failure Cr 3.22 on arrival; baseline is 1.8-2 Received IVF Renal US with asymmetric kidneys but no hydronephrosis Cr peaked at 3.5; improving to 3 Cr stabilized, suspect he has ATN due to AKI Repeat BMP in 1 week Outpatient nephro follow-up  Elevated troponin Initial troponin 106, repeat 101 EKG without acute ischemic changes Suspect elevation due to demand ischemia with hypoxia, concurrent infection Continue to monitor on telemetry   Neurogenic Bladder Bacteriuria Pt with indwelling SPC catheter, last exchange was on 8/24 per family UA grossly contaminated Clinically low suspicion for UTI at this time Urine cx positive for pseudomonas, likely due to colonization Urology performed SPC exchange on 9/20 No antibiotics indicated   Positive Blood Culture 2/2 blood cx with growth of coag neg staph 1/2 blood cx with growth of MSSA Repeat blood cx 9/20 with NGTD Suspect positive cultures are result of contaminant Given presence of S. Aureus however, will consult ID He has not had any fevers or evidence of clinical decompensation Discussed with ID, will plan for doxycyline for 7d   History of CVA with residual right-sided hemiplegia Chronic aphasia Dysphagia In wheelchair at baseline, lives with family at home Known chronic dysphagia, pt refuses to eat modified diet and will not work with SLP Family agreeable to regular diet at this time   Diabetes mellitus type 2 Continue home basal + SSI
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Tachypnoea, Troponin increased, Ultrasound kidney abnormal, Urine analysis abnormal
Clinical narrative: Patient is a 73 y.o. male patient of MD with history of hypertension, stroke, and diabetes mellitus type II who presented to Hospital with shortness of breath.   Acute Hypoxemic Respiratory Failure Covid-19 Virus Infection Date of onset of symptoms: 9/15/2023 Symptoms present on admission: dyspnea, fever, tachypnea Date of covid positive test: 9/18/2023 Vaccination status: vaccinated Imaging: Chest x-ray with bilateral atelectasis Oxygen requirements on admission: 4 L Current oxygen requirements: RA Medical therapy: steroids, remdesivir; will discontinue both as he is now stable on RA Consultants following: None Anticipated special isolation end date: 9/25/2023   Severe Sepsis Lactic Acidosis 2/2 COVID 19 infection Initial lactate was 2.2, improved to 1.8 with IVF Low suspicion for concomitant bacterial pneumonia Urine sample was collected off of chronic indwelling SPC Blood cx x 2 with NGTD Will stop CTX and azithromycin at this time Management of COVID as above   Acute on Chronic Renal Failure Cr 3.22 on arrival; baseline is 1.8-2 Received IVF Renal US with asymmetric kidneys but no hydronephrosis Cr peaked at 3.5; improving to 3 Cr stabilized, suspect he has ATN due to AKI Repeat BMP in 1 week Outpatient nephro follow-up  Elevated troponin Initial troponin 106, repeat 101 EKG without acute ischemic changes Suspect elevation due to demand ischemia with hypoxia, concurrent infection Continue to monitor on telemetry   Neurogenic Bladder Bacteriuria Pt with indwelling SPC catheter, last exchange was on 8/24 per family UA grossly contaminated Clinically low suspicion for UTI at this time Urine cx positive for pseudomonas, likely due to colonization Urology performed SPC exchange on 9/20 No antibiotics indicated   Positive Blood Culture 2/2 blood cx with growth of coag neg staph 1/2 blood cx with growth of MSSA Repeat blood cx 9/20 with NGTD Suspect positive cultures are result of contaminant Given presence of S. Aureus however, will consult ID He has not had any fevers or evidence of clinical decompensation Discussed with ID, will plan for doxycyline for 7d   History of CVA with residual right-sided hemiplegia Chronic aphasia Dysphagia In wheelchair at baseline, lives with family at home Known chronic dysphagia, pt refuses to eat modified diet and will not work with SLP Family agreeable to regular diet at this time   Diabetes mellitus type 2 Continue home basal + SSI
Age: 59.0
Sex: F
Vaccine: HEPAB, TDAP, TYP, YF
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
Clinical narrative: Client states she developed redness near the injection site with swelling. Mildly warm to the touch. Denied itching.  She stated the redness and swelling lasted for one week before fading away.
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acquired diaphragmatic eventration, Acute respiratory failure, Asthma, Atelectasis, Atrial fibrillation
Clinical narrative: Patient is a 76 y.o. male patient of CNP with history of type 2 diabetes mellitus, hypertension, BPH, obstructive sleep apnea on CPAP nightly, atrial fibrillation on Eliquis, history of gout, history of nonobstructive coronary artery disease, HFpEF, asthma/COPD on chronic O2 at 3 L/min presented to Hospital with increasing shortness breath that has been worsening over the last several days.  He denies any fevers or chills and denies any chest pain.    Acute exacerbation of COPD/Asthma with hypoxia Acute on Chronic Respiratory Failure Chest x-ray-No significant change. Continued left hemidiaphragm elevation with adjacent atelectasis Continue Augmentin Continue IV steroids, Inhalers Wean oxygen as tolerated- baseline Oxygen 3 L     Type 2 diabetes mellitus A1C 6.1  Resume home meds    Obstructive sleep apnea Continue CPAP at home settings with supplemental oxygen at 3 L/min   Hypertension We will hold Cozaar as patient had low blood pressure on arrival.   Paroxysmal atrial fibrillation We will continue Tikosyn 500 mg every 12 hours and metoprolol 25 mg daily Cardiology following   HFpEF We will continue Demadex and spironolactone Cardiology following Echocardiogram 8/21/23- EF 76% grade I diastolic dysfunction   Covid-19 Virus Infection Date of onset of symptoms: 3-4 days ago Symptoms present on admission: cough , shortness of breath Date of covid positive test: 9/18/23 Vaccination status: vaccinated Imaging: chest x-ray- left hemidiaphragm elevation with adjacent atelectasis Oxygen requirements on admission: yes Current oxygen requirements: 3 liters Consultants following: ID consult Anticipated special isolation end date: 9/28/23    Continue IV steroids, then transition to oral steroids S/p Remdesivir
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Chest X-ray abnormal, Chronic obstructive pulmonary disease, Condition aggravated, Cough, Diastolic dysfunction
Clinical narrative: Patient is a 76 y.o. male patient of CNP with history of type 2 diabetes mellitus, hypertension, BPH, obstructive sleep apnea on CPAP nightly, atrial fibrillation on Eliquis, history of gout, history of nonobstructive coronary artery disease, HFpEF, asthma/COPD on chronic O2 at 3 L/min presented to Hospital with increasing shortness breath that has been worsening over the last several days.  He denies any fevers or chills and denies any chest pain.    Acute exacerbation of COPD/Asthma with hypoxia Acute on Chronic Respiratory Failure Chest x-ray-No significant change. Continued left hemidiaphragm elevation with adjacent atelectasis Continue Augmentin Continue IV steroids, Inhalers Wean oxygen as tolerated- baseline Oxygen 3 L     Type 2 diabetes mellitus A1C 6.1  Resume home meds    Obstructive sleep apnea Continue CPAP at home settings with supplemental oxygen at 3 L/min   Hypertension We will hold Cozaar as patient had low blood pressure on arrival.   Paroxysmal atrial fibrillation We will continue Tikosyn 500 mg every 12 hours and metoprolol 25 mg daily Cardiology following   HFpEF We will continue Demadex and spironolactone Cardiology following Echocardiogram 8/21/23- EF 76% grade I diastolic dysfunction   Covid-19 Virus Infection Date of onset of symptoms: 3-4 days ago Symptoms present on admission: cough , shortness of breath Date of covid positive test: 9/18/23 Vaccination status: vaccinated Imaging: chest x-ray- left hemidiaphragm elevation with adjacent atelectasis Oxygen requirements on admission: yes Current oxygen requirements: 3 liters Consultants following: ID consult Anticipated special isolation end date: 9/28/23    Continue IV steroids, then transition to oral steroids S/p Remdesivir
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Dyspnoea, Echocardiogram abnormal, Ejection fraction normal, Glycosylated haemoglobin increased, Hypotension
Clinical narrative: Patient is a 76 y.o. male patient of CNP with history of type 2 diabetes mellitus, hypertension, BPH, obstructive sleep apnea on CPAP nightly, atrial fibrillation on Eliquis, history of gout, history of nonobstructive coronary artery disease, HFpEF, asthma/COPD on chronic O2 at 3 L/min presented to Hospital with increasing shortness breath that has been worsening over the last several days.  He denies any fevers or chills and denies any chest pain.    Acute exacerbation of COPD/Asthma with hypoxia Acute on Chronic Respiratory Failure Chest x-ray-No significant change. Continued left hemidiaphragm elevation with adjacent atelectasis Continue Augmentin Continue IV steroids, Inhalers Wean oxygen as tolerated- baseline Oxygen 3 L     Type 2 diabetes mellitus A1C 6.1  Resume home meds    Obstructive sleep apnea Continue CPAP at home settings with supplemental oxygen at 3 L/min   Hypertension We will hold Cozaar as patient had low blood pressure on arrival.   Paroxysmal atrial fibrillation We will continue Tikosyn 500 mg every 12 hours and metoprolol 25 mg daily Cardiology following   HFpEF We will continue Demadex and spironolactone Cardiology following Echocardiogram 8/21/23- EF 76% grade I diastolic dysfunction   Covid-19 Virus Infection Date of onset of symptoms: 3-4 days ago Symptoms present on admission: cough , shortness of breath Date of covid positive test: 9/18/23 Vaccination status: vaccinated Imaging: chest x-ray- left hemidiaphragm elevation with adjacent atelectasis Oxygen requirements on admission: yes Current oxygen requirements: 3 liters Consultants following: ID consult Anticipated special isolation end date: 9/28/23    Continue IV steroids, then transition to oral steroids S/p Remdesivir
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Hypoxia, SARS-CoV-2 test positive
Clinical narrative: Patient is a 76 y.o. male patient of CNP with history of type 2 diabetes mellitus, hypertension, BPH, obstructive sleep apnea on CPAP nightly, atrial fibrillation on Eliquis, history of gout, history of nonobstructive coronary artery disease, HFpEF, asthma/COPD on chronic O2 at 3 L/min presented to Hospital with increasing shortness breath that has been worsening over the last several days.  He denies any fevers or chills and denies any chest pain.    Acute exacerbation of COPD/Asthma with hypoxia Acute on Chronic Respiratory Failure Chest x-ray-No significant change. Continued left hemidiaphragm elevation with adjacent atelectasis Continue Augmentin Continue IV steroids, Inhalers Wean oxygen as tolerated- baseline Oxygen 3 L     Type 2 diabetes mellitus A1C 6.1  Resume home meds    Obstructive sleep apnea Continue CPAP at home settings with supplemental oxygen at 3 L/min   Hypertension We will hold Cozaar as patient had low blood pressure on arrival.   Paroxysmal atrial fibrillation We will continue Tikosyn 500 mg every 12 hours and metoprolol 25 mg daily Cardiology following   HFpEF We will continue Demadex and spironolactone Cardiology following Echocardiogram 8/21/23- EF 76% grade I diastolic dysfunction   Covid-19 Virus Infection Date of onset of symptoms: 3-4 days ago Symptoms present on admission: cough , shortness of breath Date of covid positive test: 9/18/23 Vaccination status: vaccinated Imaging: chest x-ray- left hemidiaphragm elevation with adjacent atelectasis Oxygen requirements on admission: yes Current oxygen requirements: 3 liters Consultants following: ID consult Anticipated special isolation end date: 9/28/23    Continue IV steroids, then transition to oral steroids S/p Remdesivir
Age: 88.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Atrial appendage closure, Atrial fibrillation, Bundle branch block right, COVID-19
Clinical narrative: Patient is a 89 y.o. female patient of DO with history of arthritis, A-fib, GERD, heart murmur, hyperlipidemia, hypertension, iron deficiency anemia, valvular disorder presented to Hospital with shortness of breath.   Acute respiratory failure with hypoxia Covid-19 Virus Infection Date of onset of symptoms: 9/21/23 Symptoms present on admission: Shortness of breath, cough, fever Date of covid positive test: 9/22/23 Vaccination status: vaccinated Imaging: CXR nonacute Oxygen requirements on admission: 2 L Current oxygen requirements: Room air as of 9/25 Medical therapy: remdesivir and steroids Consultants following: None Anticipated special isolation end date: 10/01/23 Aggressive pulmonary hygiene, I/S Was given azithromycin and Rocephin in the ED not continued on admission 9/25: Currently stable on room air.  Clinically stable for discharge after PT/OT evaluation.  To complete 10-day course of dexamethasone.  Further remdesivir not indicated this patient currently on room air.   Oral Candidiasis  White plaque on left side of mouth with some ability to scrape off  Will start Nystatin swish and spit    Hyponatremia Currently 128.  Likely secondary to hypovolemia. Holding IV fluids against acute COVID infection. Encourage nutrition. Can be followed up as outpatient with family physician. Atrial fibrillation POA EKG shows A-fib, RBBB, no ischemic changes S/p LAAO with Amulet device on 4/27/23 Continue home beta-blocker Monitor on telemetry   Chronically elevated troponin Initial troponin 22, repeat 16 Likely demand ischemia Monitor on telemetry   DM 2 No history of diabetes A1c 6.5% SSI ordered while on steroids  At goal for age.   Pulmonary hypertension follows with Dr.,  on lasix 20 mg (x3), metoprolol 100mg BID   Iron deficiency anemia Hgb 11.1 Continue home iron   GERD  continue home Protonix
Age: 88.0
Sex: F
Vaccine: COVID19-2
Symptoms: Cardiac telemetry, Chest X-ray normal, Condition aggravated, Cough, Dyspnoea
Clinical narrative: Patient is a 89 y.o. female patient of DO with history of arthritis, A-fib, GERD, heart murmur, hyperlipidemia, hypertension, iron deficiency anemia, valvular disorder presented to Hospital with shortness of breath.   Acute respiratory failure with hypoxia Covid-19 Virus Infection Date of onset of symptoms: 9/21/23 Symptoms present on admission: Shortness of breath, cough, fever Date of covid positive test: 9/22/23 Vaccination status: vaccinated Imaging: CXR nonacute Oxygen requirements on admission: 2 L Current oxygen requirements: Room air as of 9/25 Medical therapy: remdesivir and steroids Consultants following: None Anticipated special isolation end date: 10/01/23 Aggressive pulmonary hygiene, I/S Was given azithromycin and Rocephin in the ED not continued on admission 9/25: Currently stable on room air.  Clinically stable for discharge after PT/OT evaluation.  To complete 10-day course of dexamethasone.  Further remdesivir not indicated this patient currently on room air.   Oral Candidiasis  White plaque on left side of mouth with some ability to scrape off  Will start Nystatin swish and spit    Hyponatremia Currently 128.  Likely secondary to hypovolemia. Holding IV fluids against acute COVID infection. Encourage nutrition. Can be followed up as outpatient with family physician. Atrial fibrillation POA EKG shows A-fib, RBBB, no ischemic changes S/p LAAO with Amulet device on 4/27/23 Continue home beta-blocker Monitor on telemetry   Chronically elevated troponin Initial troponin 22, repeat 16 Likely demand ischemia Monitor on telemetry   DM 2 No history of diabetes A1c 6.5% SSI ordered while on steroids  At goal for age.   Pulmonary hypertension follows with Dr.,  on lasix 20 mg (x3), metoprolol 100mg BID   Iron deficiency anemia Hgb 11.1 Continue home iron   GERD  continue home Protonix
Age: 88.0
Sex: F
Vaccine: COVID19-2
Symptoms: Electrocardiogram abnormal, Glycosylated haemoglobin, Glycosylated haemoglobin normal, Haemoglobin, Hyponatraemia
Clinical narrative: Patient is a 89 y.o. female patient of DO with history of arthritis, A-fib, GERD, heart murmur, hyperlipidemia, hypertension, iron deficiency anemia, valvular disorder presented to Hospital with shortness of breath.   Acute respiratory failure with hypoxia Covid-19 Virus Infection Date of onset of symptoms: 9/21/23 Symptoms present on admission: Shortness of breath, cough, fever Date of covid positive test: 9/22/23 Vaccination status: vaccinated Imaging: CXR nonacute Oxygen requirements on admission: 2 L Current oxygen requirements: Room air as of 9/25 Medical therapy: remdesivir and steroids Consultants following: None Anticipated special isolation end date: 10/01/23 Aggressive pulmonary hygiene, I/S Was given azithromycin and Rocephin in the ED not continued on admission 9/25: Currently stable on room air.  Clinically stable for discharge after PT/OT evaluation.  To complete 10-day course of dexamethasone.  Further remdesivir not indicated this patient currently on room air.   Oral Candidiasis  White plaque on left side of mouth with some ability to scrape off  Will start Nystatin swish and spit    Hyponatremia Currently 128.  Likely secondary to hypovolemia. Holding IV fluids against acute COVID infection. Encourage nutrition. Can be followed up as outpatient with family physician. Atrial fibrillation POA EKG shows A-fib, RBBB, no ischemic changes S/p LAAO with Amulet device on 4/27/23 Continue home beta-blocker Monitor on telemetry   Chronically elevated troponin Initial troponin 22, repeat 16 Likely demand ischemia Monitor on telemetry   DM 2 No history of diabetes A1c 6.5% SSI ordered while on steroids  At goal for age.   Pulmonary hypertension follows with Dr.,  on lasix 20 mg (x3), metoprolol 100mg BID   Iron deficiency anemia Hgb 11.1 Continue home iron   GERD  continue home Protonix
Age: 88.0
Sex: F
Vaccine: COVID19-2
Symptoms: Hypovolaemia, Myocardial ischaemia, Oral candidiasis, Pulmonary hypertension, Pyrexia
Clinical narrative: Patient is a 89 y.o. female patient of DO with history of arthritis, A-fib, GERD, heart murmur, hyperlipidemia, hypertension, iron deficiency anemia, valvular disorder presented to Hospital with shortness of breath.   Acute respiratory failure with hypoxia Covid-19 Virus Infection Date of onset of symptoms: 9/21/23 Symptoms present on admission: Shortness of breath, cough, fever Date of covid positive test: 9/22/23 Vaccination status: vaccinated Imaging: CXR nonacute Oxygen requirements on admission: 2 L Current oxygen requirements: Room air as of 9/25 Medical therapy: remdesivir and steroids Consultants following: None Anticipated special isolation end date: 10/01/23 Aggressive pulmonary hygiene, I/S Was given azithromycin and Rocephin in the ED not continued on admission 9/25: Currently stable on room air.  Clinically stable for discharge after PT/OT evaluation.  To complete 10-day course of dexamethasone.  Further remdesivir not indicated this patient currently on room air.   Oral Candidiasis  White plaque on left side of mouth with some ability to scrape off  Will start Nystatin swish and spit    Hyponatremia Currently 128.  Likely secondary to hypovolemia. Holding IV fluids against acute COVID infection. Encourage nutrition. Can be followed up as outpatient with family physician. Atrial fibrillation POA EKG shows A-fib, RBBB, no ischemic changes S/p LAAO with Amulet device on 4/27/23 Continue home beta-blocker Monitor on telemetry   Chronically elevated troponin Initial troponin 22, repeat 16 Likely demand ischemia Monitor on telemetry   DM 2 No history of diabetes A1c 6.5% SSI ordered while on steroids  At goal for age.   Pulmonary hypertension follows with Dr.,  on lasix 20 mg (x3), metoprolol 100mg BID   Iron deficiency anemia Hgb 11.1 Continue home iron   GERD  continue home Protonix
Age: 88.0
Sex: F
Vaccine: COVID19-2
Symptoms: SARS-CoV-2 test positive, Troponin increased, Type 2 diabetes mellitus
Clinical narrative: Patient is a 89 y.o. female patient of DO with history of arthritis, A-fib, GERD, heart murmur, hyperlipidemia, hypertension, iron deficiency anemia, valvular disorder presented to Hospital with shortness of breath.   Acute respiratory failure with hypoxia Covid-19 Virus Infection Date of onset of symptoms: 9/21/23 Symptoms present on admission: Shortness of breath, cough, fever Date of covid positive test: 9/22/23 Vaccination status: vaccinated Imaging: CXR nonacute Oxygen requirements on admission: 2 L Current oxygen requirements: Room air as of 9/25 Medical therapy: remdesivir and steroids Consultants following: None Anticipated special isolation end date: 10/01/23 Aggressive pulmonary hygiene, I/S Was given azithromycin and Rocephin in the ED not continued on admission 9/25: Currently stable on room air.  Clinically stable for discharge after PT/OT evaluation.  To complete 10-day course of dexamethasone.  Further remdesivir not indicated this patient currently on room air.   Oral Candidiasis  White plaque on left side of mouth with some ability to scrape off  Will start Nystatin swish and spit    Hyponatremia Currently 128.  Likely secondary to hypovolemia. Holding IV fluids against acute COVID infection. Encourage nutrition. Can be followed up as outpatient with family physician. Atrial fibrillation POA EKG shows A-fib, RBBB, no ischemic changes S/p LAAO with Amulet device on 4/27/23 Continue home beta-blocker Monitor on telemetry   Chronically elevated troponin Initial troponin 22, repeat 16 Likely demand ischemia Monitor on telemetry   DM 2 No history of diabetes A1c 6.5% SSI ordered while on steroids  At goal for age.   Pulmonary hypertension follows with Dr.,  on lasix 20 mg (x3), metoprolol 100mg BID   Iron deficiency anemia Hgb 11.1 Continue home iron   GERD  continue home Protonix
Age: 21.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: VACCINE WAS  STORED IN AN UNAPPROVED STORAGE UNIT
Age: 25.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Asthma, COVID-19, Chest X-ray normal, Condition aggravated
Clinical narrative: Patient is a 27 y.o. male patient of DO with history of asthma, anxiety who presented to Hospital ED with COVID-19.   Acute Hypoxic Respiratory Failure COVID-19 Severe persistent asthma Positive COVID exposure 9/11 with development of symptoms (cough, nasal congestion, SOB) starting 9/13 with progressive worsening.  Patient has not had COVID before.  Received COVID vaccine x2 plus 1 booster.  Last hospitalization for asthma April 2022 2/2 flu and required intubation.  At HED, required 4L NC due to frequent desats <90% prompting transfer.  Received duoneb x1, dex 10mg in ED. CXR unremarkable.  Labs with leukocytosis 12.25-- >15.53-- > 12.67 Continue home inhalers (ICS/LABA, LAMA), montelukast Scheduled/prn albuterol nebs Continue dexamethasone 6mg daily-- > finish off 10 day total course on dischagre Received 2 doses remdesivir before being able to maintain on RA Continue supplemental O2 to maintain O2 sats >92% Pulmonary hygiene   Tachycardia-resolved  Tachy to 1-teens upon transfer to H Suspect in setting of acute illness, consistent albuterol use over past 72 hours.  No pleuritic chest pain.   GAD PTSD Continue home Prozac
Age: 25.0
Sex: M
Vaccine: COVID19
Symptoms: Cough, Dyspnoea, Endotracheal intubation, Exposure to SARS-CoV-2, Generalised anxiety disorder
Clinical narrative: Patient is a 27 y.o. male patient of DO with history of asthma, anxiety who presented to Hospital ED with COVID-19.   Acute Hypoxic Respiratory Failure COVID-19 Severe persistent asthma Positive COVID exposure 9/11 with development of symptoms (cough, nasal congestion, SOB) starting 9/13 with progressive worsening.  Patient has not had COVID before.  Received COVID vaccine x2 plus 1 booster.  Last hospitalization for asthma April 2022 2/2 flu and required intubation.  At HED, required 4L NC due to frequent desats <90% prompting transfer.  Received duoneb x1, dex 10mg in ED. CXR unremarkable.  Labs with leukocytosis 12.25-- >15.53-- > 12.67 Continue home inhalers (ICS/LABA, LAMA), montelukast Scheduled/prn albuterol nebs Continue dexamethasone 6mg daily-- > finish off 10 day total course on dischagre Received 2 doses remdesivir before being able to maintain on RA Continue supplemental O2 to maintain O2 sats >92% Pulmonary hygiene   Tachycardia-resolved  Tachy to 1-teens upon transfer to H Suspect in setting of acute illness, consistent albuterol use over past 72 hours.  No pleuritic chest pain.   GAD PTSD Continue home Prozac
Age: 25.0
Sex: M
Vaccine: COVID19
Symptoms: Leukocytosis, Nasal congestion, Post-traumatic stress disorder, Tachycardia
Clinical narrative: Patient is a 27 y.o. male patient of DO with history of asthma, anxiety who presented to Hospital ED with COVID-19.   Acute Hypoxic Respiratory Failure COVID-19 Severe persistent asthma Positive COVID exposure 9/11 with development of symptoms (cough, nasal congestion, SOB) starting 9/13 with progressive worsening.  Patient has not had COVID before.  Received COVID vaccine x2 plus 1 booster.  Last hospitalization for asthma April 2022 2/2 flu and required intubation.  At HED, required 4L NC due to frequent desats <90% prompting transfer.  Received duoneb x1, dex 10mg in ED. CXR unremarkable.  Labs with leukocytosis 12.25-- >15.53-- > 12.67 Continue home inhalers (ICS/LABA, LAMA), montelukast Scheduled/prn albuterol nebs Continue dexamethasone 6mg daily-- > finish off 10 day total course on dischagre Received 2 doses remdesivir before being able to maintain on RA Continue supplemental O2 to maintain O2 sats >92% Pulmonary hygiene   Tachycardia-resolved  Tachy to 1-teens upon transfer to H Suspect in setting of acute illness, consistent albuterol use over past 72 hours.  No pleuritic chest pain.   GAD PTSD Continue home Prozac
Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: VACCINE WAS  STORED IN AN UNAPPROVED STORAGE UNIT
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Diarrhoea
Clinical narrative: severe diarrhea
Age: 77.0
Sex: F
Vaccine: TDAP, VARZOS
Symptoms: Confusional state, Extra dose administered
Clinical narrative: patient confused.  thought he needed Shingrix vaccination.  Completed the series 5 years ago.  got shot #3 10-17-2023 no complications
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: VACCINE WAS  STORED IN AN UNAPPROVED STORAGE UNIT
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Death
Clinical narrative: NONE
Age: 80.0
Sex: M
Vaccine: VARZOS
Symptoms: Extra dose administered, No adverse event
Clinical narrative: patient confused.  thought he needed Shingrix vaccination.  Completed the series 5 years ago.  got shot #3 10-17-2023 no complications
Age: 24.0
Sex: M
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: VACCINE WAS  STORED IN AN UNAPPROVED STORAGE UNIT
Age: 83.0
Sex: F
Vaccine: VARZOS
Symptoms: Dizziness, Feeling cold, Hyperhidrosis, Injection site nodule, Injection site pain
Clinical narrative: Big hard knot at injection site that is tender. I got home and was very cold. I started feeling sick to my stomach and nauseous. I had a fever. In the night I was so dizzy at 2 am when i got up to use the bathroom. I was covered in sweat. I almost called EMS.
Age: 83.0
Sex: F
Vaccine: VARZOS
Symptoms: Nausea, Pyrexia
Clinical narrative: Big hard knot at injection site that is tender. I got home and was very cold. I started feeling sick to my stomach and nauseous. I had a fever. In the night I was so dizzy at 2 am when i got up to use the bathroom. I was covered in sweat. I almost called EMS.
Age: 62.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Ageusia, Anosmia, Anticoagulant therapy, Blood bicarbonate increased
Clinical narrative: Patient is a 65 y.o. male with a history of permanent A-fib, on warfarin, COPD, history of prior strokes without deficits who presented to RMH 9/16/2023 with left-sided weakness. Found to be COVID positive.   1. Suspected CVA: Concerning for TIA/stroke.  Symptoms for 3+ days.  CT head 9/16/23  nonacute. Unable to obatin MRI due to pacemaker. Repeat CT nonacute. LDL 32, A1c 5.9 on admission labs.  Continued warfarin, aspirin.  Pharmacy dosed warfarin. Daily.  Switched to Lipitor. Neurology followed. 2. COVID-19 infection:  Presented with cough, loss of taste/smell.  X-ray 9/16/2023 without focal infiltrates. Symptomatic for 5 days before testing l.   Does not meet criteria for treatment at this time except for  steroid for mild hypoxia.  Continued on dexamethasone 6 mg daily as off oxygen so discontinued at discharge..  Supportive treatment. 3. Acute hypoxic respiratory failure: Patient is on 2 L oxygen at home on as-needed basis.  Here patient is on 2 L oxygen 24/7.  Started on dexamethasone for hypoxia secondary to COVID.  No need for other therapy  as patient is symptomatic for more than 6- 7 days before getting tested. Weaned off oxygen at discharge. 4. Hyperkalemia :potassium 5.3 on 9/23.  S/p  hyperkalemic cocktail.  Will monitor potassium,   Continued to hold lisinopril.  Potassium 5.1 on 9/2423.  Stable at dc. 5. Metabolic alkalosis: Bicarb 38, likely in setting of Lasix. Held  Lasix on 9/24.  Trended down. stable. 6. Leukopenia, thrombocytopenia: WBC 1.32 and platelets 81 on 9/20.  Hematology followed.  Likely secondary to COVID-19.  WBC and platelets trended up with WBC 9.32 with platelet 202 on 9/24. Resolved. 7.  CAD: s/p RCA stent in 2004 and RCA / OM stents placed in 2013. Follows with cardiology. Echo 7/11/23 EF 55-60%.  proBNP 1539. Troponin negative x2. Continue aspirin/statin, Lasix, lisinopril, 8. Permanent  A-fib: History of ablation, pacemaker in place.  History of mitral valve repair.  Echo 7/11/2023 with moderate mitral stenosis.  Continued home dose  warfarin, Continued metoprolol.  INR goal 2-3.  9. H/O mitral valvuloplasty: at the age of 9 due to rheumatic fever.  10. History of prior strokes: CT head with small chronic lacunar infarcts in left frontal lobe.  As above. 11. COPD: On room air.  Continue home inhalers 12. Hypertension: Controlled on admit.  Continued home meds. 13. tobacco abuse: Recommend cessation.   14. Chronic pain: data reviewed.  Home meds continued,Lyrica and Percocet. 15. Code status: DNR CCA
Age: 62.0
Sex: M
Vaccine: COVID19
Symptoms: Blood potassium increased, COVID-19, Cerebrovascular accident, Chest X-ray normal, Computerised tomogram head abnormal
Clinical narrative: Patient is a 65 y.o. male with a history of permanent A-fib, on warfarin, COPD, history of prior strokes without deficits who presented to RMH 9/16/2023 with left-sided weakness. Found to be COVID positive.   1. Suspected CVA: Concerning for TIA/stroke.  Symptoms for 3+ days.  CT head 9/16/23  nonacute. Unable to obatin MRI due to pacemaker. Repeat CT nonacute. LDL 32, A1c 5.9 on admission labs.  Continued warfarin, aspirin.  Pharmacy dosed warfarin. Daily.  Switched to Lipitor. Neurology followed. 2. COVID-19 infection:  Presented with cough, loss of taste/smell.  X-ray 9/16/2023 without focal infiltrates. Symptomatic for 5 days before testing l.   Does not meet criteria for treatment at this time except for  steroid for mild hypoxia.  Continued on dexamethasone 6 mg daily as off oxygen so discontinued at discharge..  Supportive treatment. 3. Acute hypoxic respiratory failure: Patient is on 2 L oxygen at home on as-needed basis.  Here patient is on 2 L oxygen 24/7.  Started on dexamethasone for hypoxia secondary to COVID.  No need for other therapy  as patient is symptomatic for more than 6- 7 days before getting tested. Weaned off oxygen at discharge. 4. Hyperkalemia :potassium 5.3 on 9/23.  S/p  hyperkalemic cocktail.  Will monitor potassium,   Continued to hold lisinopril.  Potassium 5.1 on 9/2423.  Stable at dc. 5. Metabolic alkalosis: Bicarb 38, likely in setting of Lasix. Held  Lasix on 9/24.  Trended down. stable. 6. Leukopenia, thrombocytopenia: WBC 1.32 and platelets 81 on 9/20.  Hematology followed.  Likely secondary to COVID-19.  WBC and platelets trended up with WBC 9.32 with platelet 202 on 9/24. Resolved. 7.  CAD: s/p RCA stent in 2004 and RCA / OM stents placed in 2013. Follows with cardiology. Echo 7/11/23 EF 55-60%.  proBNP 1539. Troponin negative x2. Continue aspirin/statin, Lasix, lisinopril, 8. Permanent  A-fib: History of ablation, pacemaker in place.  History of mitral valve repair.  Echo 7/11/2023 with moderate mitral stenosis.  Continued home dose  warfarin, Continued metoprolol.  INR goal 2-3.  9. H/O mitral valvuloplasty: at the age of 9 due to rheumatic fever.  10. History of prior strokes: CT head with small chronic lacunar infarcts in left frontal lobe.  As above. 11. COPD: On room air.  Continue home inhalers 12. Hypertension: Controlled on admit.  Continued home meds. 13. tobacco abuse: Recommend cessation.   14. Chronic pain: data reviewed.  Home meds continued,Lyrica and Percocet. 15. Code status: DNR CCA
Age: 62.0
Sex: M
Vaccine: COVID19
Symptoms: Cough, Echocardiogram abnormal, Ejection fraction normal, Glycosylated haemoglobin normal, Hemiparesis
Clinical narrative: Patient is a 65 y.o. male with a history of permanent A-fib, on warfarin, COPD, history of prior strokes without deficits who presented to RMH 9/16/2023 with left-sided weakness. Found to be COVID positive.   1. Suspected CVA: Concerning for TIA/stroke.  Symptoms for 3+ days.  CT head 9/16/23  nonacute. Unable to obatin MRI due to pacemaker. Repeat CT nonacute. LDL 32, A1c 5.9 on admission labs.  Continued warfarin, aspirin.  Pharmacy dosed warfarin. Daily.  Switched to Lipitor. Neurology followed. 2. COVID-19 infection:  Presented with cough, loss of taste/smell.  X-ray 9/16/2023 without focal infiltrates. Symptomatic for 5 days before testing l.   Does not meet criteria for treatment at this time except for  steroid for mild hypoxia.  Continued on dexamethasone 6 mg daily as off oxygen so discontinued at discharge..  Supportive treatment. 3. Acute hypoxic respiratory failure: Patient is on 2 L oxygen at home on as-needed basis.  Here patient is on 2 L oxygen 24/7.  Started on dexamethasone for hypoxia secondary to COVID.  No need for other therapy  as patient is symptomatic for more than 6- 7 days before getting tested. Weaned off oxygen at discharge. 4. Hyperkalemia :potassium 5.3 on 9/23.  S/p  hyperkalemic cocktail.  Will monitor potassium,   Continued to hold lisinopril.  Potassium 5.1 on 9/2423.  Stable at dc. 5. Metabolic alkalosis: Bicarb 38, likely in setting of Lasix. Held  Lasix on 9/24.  Trended down. stable. 6. Leukopenia, thrombocytopenia: WBC 1.32 and platelets 81 on 9/20.  Hematology followed.  Likely secondary to COVID-19.  WBC and platelets trended up with WBC 9.32 with platelet 202 on 9/24. Resolved. 7.  CAD: s/p RCA stent in 2004 and RCA / OM stents placed in 2013. Follows with cardiology. Echo 7/11/23 EF 55-60%.  proBNP 1539. Troponin negative x2. Continue aspirin/statin, Lasix, lisinopril, 8. Permanent  A-fib: History of ablation, pacemaker in place.  History of mitral valve repair.  Echo 7/11/2023 with moderate mitral stenosis.  Continued home dose  warfarin, Continued metoprolol.  INR goal 2-3.  9. H/O mitral valvuloplasty: at the age of 9 due to rheumatic fever.  10. History of prior strokes: CT head with small chronic lacunar infarcts in left frontal lobe.  As above. 11. COPD: On room air.  Continue home inhalers 12. Hypertension: Controlled on admit.  Continued home meds. 13. tobacco abuse: Recommend cessation.   14. Chronic pain: data reviewed.  Home meds continued,Lyrica and Percocet. 15. Code status: DNR CCA