chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Thrombocytopenia, Type 2 diabetes mellitus, Urine antigen test
Clinical narrative: Patient is a 86 y.o. male patient with history of CAD, HTN, DVT/PE, GI bleed, NIDDM2, prostate cancer who presented to Hospital with weakness, chills.   Acute respiratory failure with hypoxia With recent viral URI symptoms 2 weeks prior to admission, though had negative rapid antigen at home at that time, possibly symptoms from new COVID or potential secondary bacterial pneumonia CXR on admission with few increased markings in the right infrahilar region.  Findings could represent atelectasis or an early infiltrate  Requiring 2L nasal cannula on admission Procalcitonin, urine antigens negative- stopped empirin antibiotics  Continue dexamethasone, held remdesivir given unclear timing Weaned off oxygen   COVID-19 virus infection Date of onset of symptoms: unclear, had URI symptoms 2-3 weeks ago with improvement, then fatigue, weakness, chills on 10/26 Date of covid positive test: 10/26 Vaccination status: vaccinated without most recent booster Imaging: CXR as above Oxygen requirements on admission: 2L Current oxygen requirements: 2L Medical therapy: steroids, antibiotics as above, holding remdesivir given unclear timing of symptoms Consultants following: PT/OT Anticipated special isolation end date while in hospital: 11/5 Stable on room air Patient advised about precautions after discharge    Chronic Thrombocytopenia Has been low in past   CAD Prior CABG remotely and stent Continue home imdur, aspirin, Xarelto, statin   History of DVT/PE Continue home Xarelto   HTN On hydrochlorothiazide, losartan, imdur at home Resume home regimen   Chronic HFpEF Continue home hydrochlorothiazide  Patient to start Entresto soon on discharge    History of GI bleed In April 2023, found to have small bowel AVMs PPI BID continued   NIDDM2 On metformin at home SSI while admitted Poor control due to steroids    OSA CPAP
Age: 73.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Asthenia, Atelectasis, COVID-19, Chronic obstructive pulmonary disease
Clinical narrative: 74 y.o. male patient of No, Physician with history of COPD presented with COPD exacerbation and covid   COPD exacerbation Acute Hypoxic Respiratory Failure Covid-19 Virus Infection Patient presented with fall in bathtub and EMS was called Found to be hypoxic with on 5L Normally on 3L at baseline at baseline and 10 L with exertion Date of onset of symptoms: 10/26 Symptoms present on admission: Worsening hypoxia and weakness Date of covid positive test: 10/26 Vaccination status: vaccinated Imaging:  Emphysematous changes with mild bibasilar opacities that are felt to represent atelectasis Oxygen requirements on admission: BiPAP Current oxygen requirements: 4L Medical therapy: remdesivir and steroids, Unasyn (for COPD exacerbation) Consultants following: none Continue COPD exacerbation treatment with steroids, unasyn, albuterol Continue home inhaled steroids Follows up with pulmonologist.  Steroids on discharge On home O2   Falls Noted multiple mechanical falls at home, most recently in the bathtub No complaints of pain PT/ OT consulted.  Recommended no therapy.  Patient's O2 requirement increased to 10 L with ambulation which is baseline requirement   HTN Continue home BB
Age: 73.0
Sex: M
Vaccine: COVID19-2
Symptoms: Condition aggravated, Fall, Hypertension, Hypoxia, Imaging procedure abnormal
Clinical narrative: 74 y.o. male patient of No, Physician with history of COPD presented with COPD exacerbation and covid   COPD exacerbation Acute Hypoxic Respiratory Failure Covid-19 Virus Infection Patient presented with fall in bathtub and EMS was called Found to be hypoxic with on 5L Normally on 3L at baseline at baseline and 10 L with exertion Date of onset of symptoms: 10/26 Symptoms present on admission: Worsening hypoxia and weakness Date of covid positive test: 10/26 Vaccination status: vaccinated Imaging:  Emphysematous changes with mild bibasilar opacities that are felt to represent atelectasis Oxygen requirements on admission: BiPAP Current oxygen requirements: 4L Medical therapy: remdesivir and steroids, Unasyn (for COPD exacerbation) Consultants following: none Continue COPD exacerbation treatment with steroids, unasyn, albuterol Continue home inhaled steroids Follows up with pulmonologist.  Steroids on discharge On home O2   Falls Noted multiple mechanical falls at home, most recently in the bathtub No complaints of pain PT/ OT consulted.  Recommended no therapy.  Patient's O2 requirement increased to 10 L with ambulation which is baseline requirement   HTN Continue home BB
Age: 73.0
Sex: M
Vaccine: COVID19-2
Symptoms: Lung opacity, Positive airway pressure therapy, SARS-CoV-2 test positive
Clinical narrative: 74 y.o. male patient of No, Physician with history of COPD presented with COPD exacerbation and covid   COPD exacerbation Acute Hypoxic Respiratory Failure Covid-19 Virus Infection Patient presented with fall in bathtub and EMS was called Found to be hypoxic with on 5L Normally on 3L at baseline at baseline and 10 L with exertion Date of onset of symptoms: 10/26 Symptoms present on admission: Worsening hypoxia and weakness Date of covid positive test: 10/26 Vaccination status: vaccinated Imaging:  Emphysematous changes with mild bibasilar opacities that are felt to represent atelectasis Oxygen requirements on admission: BiPAP Current oxygen requirements: 4L Medical therapy: remdesivir and steroids, Unasyn (for COPD exacerbation) Consultants following: none Continue COPD exacerbation treatment with steroids, unasyn, albuterol Continue home inhaled steroids Follows up with pulmonologist.  Steroids on discharge On home O2   Falls Noted multiple mechanical falls at home, most recently in the bathtub No complaints of pain PT/ OT consulted.  Recommended no therapy.  Patient's O2 requirement increased to 10 L with ambulation which is baseline requirement   HTN Continue home BB
Age: 51.0
Sex: M
Vaccine: COVID19-2
Symptoms: Aspiration pleural cavity, Atrial fibrillation, Cardiac failure acute, Cardiac failure congestive, Cardiac valve rupture
Clinical narrative: PATIENT RECEVIED VACCINE AROUND 5:30PM AND BY THAT EVENING HE DEVELOPED A FEVER OF 104 DEGREES, MUSCLE PAIN, HEADACHE, AND CHILLS.  THIS LASTED FOR 2 DAYS. ON 11/13/23 HE GOT UVEITIS OF BOTH EYES. ON 11/15/23 HE WENT INTO ATRIAL FIBRILLATION AND HIS MITRAL VALVE RUPTURED. HE WAS TRANSFERRED TO A DIFFERENT HOSPITAL TO UNDERGO REPAIR.  HE NOW HAS ACUTE CONGESTION HEART FAILURE AND A PLEURAL EFFUSION. HE HAS HAD TO HAVE FLUID DRAINED OFF OF HIS LUNGS ONCE.  HE IS CURRENTLY NOT ABLE TO WORK AND IS STILL RECEIVING TREATMENT.
Age: 51.0
Sex: M
Vaccine: COVID19-2
Symptoms: Chills, Headache, Impaired work ability, Mitral valve repair, Myalgia
Clinical narrative: PATIENT RECEVIED VACCINE AROUND 5:30PM AND BY THAT EVENING HE DEVELOPED A FEVER OF 104 DEGREES, MUSCLE PAIN, HEADACHE, AND CHILLS.  THIS LASTED FOR 2 DAYS. ON 11/13/23 HE GOT UVEITIS OF BOTH EYES. ON 11/15/23 HE WENT INTO ATRIAL FIBRILLATION AND HIS MITRAL VALVE RUPTURED. HE WAS TRANSFERRED TO A DIFFERENT HOSPITAL TO UNDERGO REPAIR.  HE NOW HAS ACUTE CONGESTION HEART FAILURE AND A PLEURAL EFFUSION. HE HAS HAD TO HAVE FLUID DRAINED OFF OF HIS LUNGS ONCE.  HE IS CURRENTLY NOT ABLE TO WORK AND IS STILL RECEIVING TREATMENT.
Age: 51.0
Sex: M
Vaccine: COVID19-2
Symptoms: Pleural effusion, Pyrexia, Uveitis
Clinical narrative: PATIENT RECEVIED VACCINE AROUND 5:30PM AND BY THAT EVENING HE DEVELOPED A FEVER OF 104 DEGREES, MUSCLE PAIN, HEADACHE, AND CHILLS.  THIS LASTED FOR 2 DAYS. ON 11/13/23 HE GOT UVEITIS OF BOTH EYES. ON 11/15/23 HE WENT INTO ATRIAL FIBRILLATION AND HIS MITRAL VALVE RUPTURED. HE WAS TRANSFERRED TO A DIFFERENT HOSPITAL TO UNDERGO REPAIR.  HE NOW HAS ACUTE CONGESTION HEART FAILURE AND A PLEURAL EFFUSION. HE HAS HAD TO HAVE FLUID DRAINED OFF OF HIS LUNGS ONCE.  HE IS CURRENTLY NOT ABLE TO WORK AND IS STILL RECEIVING TREATMENT.
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough
Clinical narrative: Patient. is a 74 y.o. male with a history of COPD, CAD, CKD, AAA, HTN who presented to Facility 10/27/2023 with 5 days of progressive cough and dyspnea. Patient found to be COVID positive.    1. Acute Hypoxemic Respiratory Failure: Suspect secondary to acute COVID pneumonia requiring 2-3 L on admission. Weaned off O2 since 10/29/23.  2. Acute COVID-19 Pneumonia: Symptom onset 10/23/23. COVID-19 PCR positive 10/27/23. Partially vaccinated status. CXR on admit with hazy RLL infiltrates. Decadron and remdesivir initiated 10/28/23, no indication to continue on discharge.   3. COPD: Managed on Striverdi Respimat (LABA monotherapy). No exacerbation on admission. Continued home inhalers. 4. CAD: Stent in 2001. Continued home aspirin and statin. 5. CKD 3B: Baseline Cr 1.4-1.6. Stable on admission. 6. HTN: Continued home Norvasc. 7. Hx of RP Fibrosis: Follows at CCF s/p 2 surgeries. Continued outpatient follow-up as scheduled. 8. Hx of AAA: Known history previously mild at 3 cm and stable. Follow-up as scheduled outpatient.
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea, Lung infiltration, SARS-CoV-2 test positive
Clinical narrative: Patient. is a 74 y.o. male with a history of COPD, CAD, CKD, AAA, HTN who presented to Facility 10/27/2023 with 5 days of progressive cough and dyspnea. Patient found to be COVID positive.    1. Acute Hypoxemic Respiratory Failure: Suspect secondary to acute COVID pneumonia requiring 2-3 L on admission. Weaned off O2 since 10/29/23.  2. Acute COVID-19 Pneumonia: Symptom onset 10/23/23. COVID-19 PCR positive 10/27/23. Partially vaccinated status. CXR on admit with hazy RLL infiltrates. Decadron and remdesivir initiated 10/28/23, no indication to continue on discharge.   3. COPD: Managed on Striverdi Respimat (LABA monotherapy). No exacerbation on admission. Continued home inhalers. 4. CAD: Stent in 2001. Continued home aspirin and statin. 5. CKD 3B: Baseline Cr 1.4-1.6. Stable on admission. 6. HTN: Continued home Norvasc. 7. Hx of RP Fibrosis: Follows at CCF s/p 2 surgeries. Continued outpatient follow-up as scheduled. 8. Hx of AAA: Known history previously mild at 3 cm and stable. Follow-up as scheduled outpatient.
Age: 85.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute myocardial infarction, Acute respiratory failure, Arthralgia, Asthenia, Avulsion fracture
Clinical narrative: Patient is a 86 y.o. female with a history of stroke, remote DVT, Afib on Coumadin, hypertension who presented to Facility 10/21/2023 with generalized weakness leading to a fall in which she hit her head. She was found to have COVID infection and wrist fracture. Course prolonged by placement.   1. Acute Hypoxic Respiratory Failure: in setting of COVID. Weaned off O2 10/24/23.  2. COVID-19 Infection: vaccinated. Presented with 1 day of weakness and sore throat. Denied cough, shortness of breath, chest pain. COVID-19 positive on 10/21/23. Blood cx 10/21/23 remained negative. Pt declined steroids; agreeable to remdesivir which she completed on 10/25/23. Isolation per protocol through 10/31/23 while at Facility. 3. Fall: Lost footing with possible loss of consciousness, hit her head. Admit CTH, CT MXF, CT C/L-spine without acute process. Xray left wrist below, xray left hip below, xray right wrist unremarkable. PTOT recommended upto 5 days.  4. Left Wrist Fracture: secondary to fall. Admit X-ray showed distal radius and nondisplaced ulnar styloid avulsion fractures. Ortho recommended splint and NWB; follow up in 2 weeks with Dr. (ortho).  5. Left Hip Pain: Unable to get MRI due to cardiac device. CT hip 10/22/23 nonacute. Orthopedic team recommended WBAT and pain control.  6. Type II NSTEMI: due to demand ischemia. Admit troponin 22, 34 with positive delta, ECG without acute ischemic changes but noted indeterminate septal infarct. Suspect demand ischemia in setting of COVID. TTE 10/22/23 showed EF 70-75%, no WMA. 7. PAF: per history. Admit EKG with NSR, INR 1.3. Follows with coumadin clinic. Not on any rate controlling meds. Coumadin continued.  8. Hypertension: per history. Continue home med.  9. Stroke: per history, continued Plavix. Held statin while on remdesivir.  10. Code Status: DNR-CCA, DNI 11. DVT Prophylaxis: coumadin
Age: 85.0
Sex: F
Vaccine: COVID19-2
Symptoms: Blood culture negative, COVID-19, Computerised tomogram head normal, Computerised tomogram normal, Computerised tomogram spine
Clinical narrative: Patient is a 86 y.o. female with a history of stroke, remote DVT, Afib on Coumadin, hypertension who presented to Facility 10/21/2023 with generalized weakness leading to a fall in which she hit her head. She was found to have COVID infection and wrist fracture. Course prolonged by placement.   1. Acute Hypoxic Respiratory Failure: in setting of COVID. Weaned off O2 10/24/23.  2. COVID-19 Infection: vaccinated. Presented with 1 day of weakness and sore throat. Denied cough, shortness of breath, chest pain. COVID-19 positive on 10/21/23. Blood cx 10/21/23 remained negative. Pt declined steroids; agreeable to remdesivir which she completed on 10/25/23. Isolation per protocol through 10/31/23 while at Facility. 3. Fall: Lost footing with possible loss of consciousness, hit her head. Admit CTH, CT MXF, CT C/L-spine without acute process. Xray left wrist below, xray left hip below, xray right wrist unremarkable. PTOT recommended upto 5 days.  4. Left Wrist Fracture: secondary to fall. Admit X-ray showed distal radius and nondisplaced ulnar styloid avulsion fractures. Ortho recommended splint and NWB; follow up in 2 weeks with Dr. (ortho).  5. Left Hip Pain: Unable to get MRI due to cardiac device. CT hip 10/22/23 nonacute. Orthopedic team recommended WBAT and pain control.  6. Type II NSTEMI: due to demand ischemia. Admit troponin 22, 34 with positive delta, ECG without acute ischemic changes but noted indeterminate septal infarct. Suspect demand ischemia in setting of COVID. TTE 10/22/23 showed EF 70-75%, no WMA. 7. PAF: per history. Admit EKG with NSR, INR 1.3. Follows with coumadin clinic. Not on any rate controlling meds. Coumadin continued.  8. Hypertension: per history. Continue home med.  9. Stroke: per history, continued Plavix. Held statin while on remdesivir.  10. Code Status: DNR-CCA, DNI 11. DVT Prophylaxis: coumadin
Age: 85.0
Sex: F
Vaccine: COVID19-2
Symptoms: Echocardiogram, Echocardiogram normal, Ejection fraction normal, Electrocardiogram abnormal, Fall
Clinical narrative: Patient is a 86 y.o. female with a history of stroke, remote DVT, Afib on Coumadin, hypertension who presented to Facility 10/21/2023 with generalized weakness leading to a fall in which she hit her head. She was found to have COVID infection and wrist fracture. Course prolonged by placement.   1. Acute Hypoxic Respiratory Failure: in setting of COVID. Weaned off O2 10/24/23.  2. COVID-19 Infection: vaccinated. Presented with 1 day of weakness and sore throat. Denied cough, shortness of breath, chest pain. COVID-19 positive on 10/21/23. Blood cx 10/21/23 remained negative. Pt declined steroids; agreeable to remdesivir which she completed on 10/25/23. Isolation per protocol through 10/31/23 while at Facility. 3. Fall: Lost footing with possible loss of consciousness, hit her head. Admit CTH, CT MXF, CT C/L-spine without acute process. Xray left wrist below, xray left hip below, xray right wrist unremarkable. PTOT recommended upto 5 days.  4. Left Wrist Fracture: secondary to fall. Admit X-ray showed distal radius and nondisplaced ulnar styloid avulsion fractures. Ortho recommended splint and NWB; follow up in 2 weeks with Dr. (ortho).  5. Left Hip Pain: Unable to get MRI due to cardiac device. CT hip 10/22/23 nonacute. Orthopedic team recommended WBAT and pain control.  6. Type II NSTEMI: due to demand ischemia. Admit troponin 22, 34 with positive delta, ECG without acute ischemic changes but noted indeterminate septal infarct. Suspect demand ischemia in setting of COVID. TTE 10/22/23 showed EF 70-75%, no WMA. 7. PAF: per history. Admit EKG with NSR, INR 1.3. Follows with coumadin clinic. Not on any rate controlling meds. Coumadin continued.  8. Hypertension: per history. Continue home med.  9. Stroke: per history, continued Plavix. Held statin while on remdesivir.  10. Code Status: DNR-CCA, DNI 11. DVT Prophylaxis: coumadin
Age: 85.0
Sex: F
Vaccine: COVID19-2
Symptoms: Head injury, International normalised ratio increased, Myocardial infarction, Myocardial ischaemia, Oropharyngeal pain
Clinical narrative: Patient is a 86 y.o. female with a history of stroke, remote DVT, Afib on Coumadin, hypertension who presented to Facility 10/21/2023 with generalized weakness leading to a fall in which she hit her head. She was found to have COVID infection and wrist fracture. Course prolonged by placement.   1. Acute Hypoxic Respiratory Failure: in setting of COVID. Weaned off O2 10/24/23.  2. COVID-19 Infection: vaccinated. Presented with 1 day of weakness and sore throat. Denied cough, shortness of breath, chest pain. COVID-19 positive on 10/21/23. Blood cx 10/21/23 remained negative. Pt declined steroids; agreeable to remdesivir which she completed on 10/25/23. Isolation per protocol through 10/31/23 while at Facility. 3. Fall: Lost footing with possible loss of consciousness, hit her head. Admit CTH, CT MXF, CT C/L-spine without acute process. Xray left wrist below, xray left hip below, xray right wrist unremarkable. PTOT recommended upto 5 days.  4. Left Wrist Fracture: secondary to fall. Admit X-ray showed distal radius and nondisplaced ulnar styloid avulsion fractures. Ortho recommended splint and NWB; follow up in 2 weeks with Dr. (ortho).  5. Left Hip Pain: Unable to get MRI due to cardiac device. CT hip 10/22/23 nonacute. Orthopedic team recommended WBAT and pain control.  6. Type II NSTEMI: due to demand ischemia. Admit troponin 22, 34 with positive delta, ECG without acute ischemic changes but noted indeterminate septal infarct. Suspect demand ischemia in setting of COVID. TTE 10/22/23 showed EF 70-75%, no WMA. 7. PAF: per history. Admit EKG with NSR, INR 1.3. Follows with coumadin clinic. Not on any rate controlling meds. Coumadin continued.  8. Hypertension: per history. Continue home med.  9. Stroke: per history, continued Plavix. Held statin while on remdesivir.  10. Code Status: DNR-CCA, DNI 11. DVT Prophylaxis: coumadin
Age: 85.0
Sex: F
Vaccine: COVID19-2
Symptoms: Radius fracture, SARS-CoV-2 test positive, Sinus rhythm, Troponin increased, Ulna fracture
Clinical narrative: Patient is a 86 y.o. female with a history of stroke, remote DVT, Afib on Coumadin, hypertension who presented to Facility 10/21/2023 with generalized weakness leading to a fall in which she hit her head. She was found to have COVID infection and wrist fracture. Course prolonged by placement.   1. Acute Hypoxic Respiratory Failure: in setting of COVID. Weaned off O2 10/24/23.  2. COVID-19 Infection: vaccinated. Presented with 1 day of weakness and sore throat. Denied cough, shortness of breath, chest pain. COVID-19 positive on 10/21/23. Blood cx 10/21/23 remained negative. Pt declined steroids; agreeable to remdesivir which she completed on 10/25/23. Isolation per protocol through 10/31/23 while at Facility. 3. Fall: Lost footing with possible loss of consciousness, hit her head. Admit CTH, CT MXF, CT C/L-spine without acute process. Xray left wrist below, xray left hip below, xray right wrist unremarkable. PTOT recommended upto 5 days.  4. Left Wrist Fracture: secondary to fall. Admit X-ray showed distal radius and nondisplaced ulnar styloid avulsion fractures. Ortho recommended splint and NWB; follow up in 2 weeks with Dr. (ortho).  5. Left Hip Pain: Unable to get MRI due to cardiac device. CT hip 10/22/23 nonacute. Orthopedic team recommended WBAT and pain control.  6. Type II NSTEMI: due to demand ischemia. Admit troponin 22, 34 with positive delta, ECG without acute ischemic changes but noted indeterminate septal infarct. Suspect demand ischemia in setting of COVID. TTE 10/22/23 showed EF 70-75%, no WMA. 7. PAF: per history. Admit EKG with NSR, INR 1.3. Follows with coumadin clinic. Not on any rate controlling meds. Coumadin continued.  8. Hypertension: per history. Continue home med.  9. Stroke: per history, continued Plavix. Held statin while on remdesivir.  10. Code Status: DNR-CCA, DNI 11. DVT Prophylaxis: coumadin
Age: 85.0
Sex: F
Vaccine: COVID19-2
Symptoms: Wall motion score index normal, Wrist fracture, X-ray limb abnormal, X-ray limb normal, X-ray of pelvis and hip normal
Clinical narrative: Patient is a 86 y.o. female with a history of stroke, remote DVT, Afib on Coumadin, hypertension who presented to Facility 10/21/2023 with generalized weakness leading to a fall in which she hit her head. She was found to have COVID infection and wrist fracture. Course prolonged by placement.   1. Acute Hypoxic Respiratory Failure: in setting of COVID. Weaned off O2 10/24/23.  2. COVID-19 Infection: vaccinated. Presented with 1 day of weakness and sore throat. Denied cough, shortness of breath, chest pain. COVID-19 positive on 10/21/23. Blood cx 10/21/23 remained negative. Pt declined steroids; agreeable to remdesivir which she completed on 10/25/23. Isolation per protocol through 10/31/23 while at Facility. 3. Fall: Lost footing with possible loss of consciousness, hit her head. Admit CTH, CT MXF, CT C/L-spine without acute process. Xray left wrist below, xray left hip below, xray right wrist unremarkable. PTOT recommended upto 5 days.  4. Left Wrist Fracture: secondary to fall. Admit X-ray showed distal radius and nondisplaced ulnar styloid avulsion fractures. Ortho recommended splint and NWB; follow up in 2 weeks with Dr. (ortho).  5. Left Hip Pain: Unable to get MRI due to cardiac device. CT hip 10/22/23 nonacute. Orthopedic team recommended WBAT and pain control.  6. Type II NSTEMI: due to demand ischemia. Admit troponin 22, 34 with positive delta, ECG without acute ischemic changes but noted indeterminate septal infarct. Suspect demand ischemia in setting of COVID. TTE 10/22/23 showed EF 70-75%, no WMA. 7. PAF: per history. Admit EKG with NSR, INR 1.3. Follows with coumadin clinic. Not on any rate controlling meds. Coumadin continued.  8. Hypertension: per history. Continue home med.  9. Stroke: per history, continued Plavix. Held statin while on remdesivir.  10. Code Status: DNR-CCA, DNI 11. DVT Prophylaxis: coumadin
Age: 6.17
Sex: M
Vaccine: COVID19, FLU4
Symptoms: Chest X-ray normal, Computerised tomogram normal, Deep vein thrombosis, Pain in extremity, Peripheral swelling
Clinical narrative: Swelling + soreness left lower leg 48 hours post  injections.  Continued until MD visit 6 weeks post, (11/2023)  when diagnosis of DVT left leg (ultrasound).  All other tests (chest xray 11/2022), cat scan (02/22/2023), and diagnostic endoscope (June 21, 2023)  all negative.    Rx abixaban started (10mg x 2, then 5 mg x 2, currently 2.5 mg x2) and continuing.    Possible link of DVT to simultaneous vaccinations of 10/03/2022 suspected upon preprint publication Oct 2023, and ACIP notice of October 2023 on possible link of simultraneous COVID and influenza vaccines among patients over 65-70 and ischemic stroke.   Followup with Dr. (see above) 11/29/2023.
Age: 6.17
Sex: M
Vaccine: COVID19, FLU4
Symptoms: Ultrasound Doppler abnormal
Clinical narrative: Swelling + soreness left lower leg 48 hours post  injections.  Continued until MD visit 6 weeks post, (11/2023)  when diagnosis of DVT left leg (ultrasound).  All other tests (chest xray 11/2022), cat scan (02/22/2023), and diagnostic endoscope (June 21, 2023)  all negative.    Rx abixaban started (10mg x 2, then 5 mg x 2, currently 2.5 mg x2) and continuing.    Possible link of DVT to simultaneous vaccinations of 10/03/2022 suspected upon preprint publication Oct 2023, and ACIP notice of October 2023 on possible link of simultraneous COVID and influenza vaccines among patients over 65-70 and ischemic stroke.   Followup with Dr. (see above) 11/29/2023.
Age: 26.0
Sex: F
Vaccine: RSV
Symptoms: Exposure during pregnancy, Inappropriate schedule of product administration
Clinical narrative: Patient was given the Abrysvo vaccine 3 days early at 31w4d instead of 32w0d-36w6d.
Age: 61.0
Sex: F
Vaccine: PNC20
Symptoms: Injection site reaction, Injection site swelling, Injection site warmth, Pruritus
Clinical narrative: Day after vaccine administration patient noticed right arm to be red, swollen and itchy. When it was still swollen almost a week later patient came back to pharmacy to check about reaction. Patient has no limitation of movement in arm and no pain but arm was very swollen and red down from injection site almost to elbow and was slightly warm. Patient stated that it was better than it had been and was continually improving. Noted to patient that she could use ice to help with swelling and take benadryl if itching was bothersome. Also noted to contact us again if it did not continue to improve or if anything changed in regard to her reaction.
Age: 77.0
Sex: F
Vaccine: COVID19
Symptoms: Arthralgia, Pain in extremity
Clinical narrative: At 5:00 pm 11/29/2023, I began to have pain in my arthritic joints.  Fingers, knees, hips.  In addition pain in my shoulders where I had had mini-rotator cuffs surgeries. This continued all night and became quite severe.  this had never happened with Pfizer (4 prior COVID vax).  I will never have Moderna again.
Age: 52.0
Sex: F
Vaccine: COVID19, FLU4
Symptoms: Back pain, Dizziness, Dyspnoea, Electrocardiogram, Immediate post-injection reaction
Clinical narrative: Patient received Covid vaccine in left arm and then received Influenza vaccine in right arm.  Immediately following receiving the Influenza vaccine patient became dizzy, c/o upper back pain, and SOB.  RN and provider called to room.  Patient assisted to lying position, cool wash cloth placed to the nape of the neck, and VS's checked while provider assessed also.  EKG ordered.  Patient gradually improved over the course of approximately 15 minutes and left the office in good condition.
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19
Clinical narrative: hospitalized with COVID
Age: 67.0
Sex: F
Vaccine: FLU4, PPV, RSV
Symptoms: Cystitis, Dizziness, Guillain-Barre syndrome, Hypothyroidism, Photopsia
Clinical narrative: Pt received vaccines on 12/19, on 12/20 pt and her husband were on a plane with a layover, while on the layover, pt developed severe dizziness, felt like she was falling backwards, and vision problems - seeing stars.  Was transported to hospital.  Working Dx: Post vacc GBS, Phenytoin toxicity, toxic metabolic encephalopathy, severe hypothyroidism, acute cystitis.
Age: 67.0
Sex: F
Vaccine: FLU4, PPV, RSV
Symptoms: Sensory disturbance, Toxic encephalopathy, Toxicity to various agents, Visual impairment
Clinical narrative: Pt received vaccines on 12/19, on 12/20 pt and her husband were on a plane with a layover, while on the layover, pt developed severe dizziness, felt like she was falling backwards, and vision problems - seeing stars.  Was transported to hospital.  Working Dx: Post vacc GBS, Phenytoin toxicity, toxic metabolic encephalopathy, severe hypothyroidism, acute cystitis.
Age: 50.0
Sex: F
Vaccine: VARZOS
Symptoms: Rash
Clinical narrative: When I came home from work on Monday, I realized that I had a rash on my stomach, armpits, and hips.  After taking a shower the next morning, the rash was very apparent and was also on my lower back just above buttocks and near jawline on face/neck.  I took Benadryl for several days.  The rash went away by Friday.
Age: 62.0
Sex: F
Vaccine: COVID19, RSV
Symptoms: Chills, Dizziness, Headache, Labyrinthitis, Myalgia
Clinical narrative: No RSV reaction at all - I could even sleep on my left side; COVID vaccine had usual (for me) side effects about 12-15 hrs later: chills, muscle aches, headache, very sore upper arm. Slept on left side (not typical for me) for 4-5 nights. Vertigo began during a Pilates workout two days after Rt arm no longer sore. Vertigo has NOT been a side effect of COVID vaccinations/boosters for me. A little lightheadedness during the 1st 2 vaccines in 2021, but 12/18/2023 was full-on vertigo symptoms.
Age: 62.0
Sex: F
Vaccine: COVID19, RSV
Symptoms: Pain in extremity, Sleep disorder, Vertigo
Clinical narrative: No RSV reaction at all - I could even sleep on my left side; COVID vaccine had usual (for me) side effects about 12-15 hrs later: chills, muscle aches, headache, very sore upper arm. Slept on left side (not typical for me) for 4-5 nights. Vertigo began during a Pilates workout two days after Rt arm no longer sore. Vertigo has NOT been a side effect of COVID vaccinations/boosters for me. A little lightheadedness during the 1st 2 vaccines in 2021, but 12/18/2023 was full-on vertigo symptoms.
Age: 78.0
Sex: F
Vaccine: RSV
Symptoms: Chills, Haematocrit decreased, Haemoglobin decreased, Pain, Pyrexia
Clinical narrative: I had chills, fever, body aches for about 30 hours after receiving vaccination. Also my red blood cell count has dropped precipitously since then.
Age: 78.0
Sex: F
Vaccine: RSV
Symptoms: Red blood cell count decreased
Clinical narrative: I had chills, fever, body aches for about 30 hours after receiving vaccination. Also my red blood cell count has dropped precipitously since then.
Age: 30.0
Sex: M
Vaccine: COVID19
Symptoms: Pruritus, Urticaria
Clinical narrative: Patient received flu vaccine and COVID vaccine in the same arm.  Within minutes of receiving the vaccine he reported whole body itching and had hives on his left forearm.  His vital signs remained stable. He did not develop respiratory symptoms. He received one Benadryl.  The hives rapidly resolved.
Age: 16.0
Sex: M
Vaccine: DF
Symptoms: Inappropriate schedule of product administration, No adverse event
Clinical narrative: There were no adverse events to vaccination. The vaccine was administered ahead of time. Patient was diagnosed with Dengue on 10-19-2023, and according to the protocol he had to wait 6 months to receive the first dose. Mother was advised on 3 occasions by different health professionals, she verbalized to the nurse that the administration of the vaccine that was scheduled for 05-19-2023 could be brought forward due to her son's sporting reasons. The nurse proceeded with the vaccination without his knowledge. The report is being made so that the wrong schedule administration is documented, but there were NO adverse effects to the vaccination.
Age: 83.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: COVID-19
Clinical narrative: Hospitalized for COVID complications on 12/25/2023.
Age: 53.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19
Clinical narrative: hospitalized with COVID
Age: 74.0
Sex: F
Vaccine: RSV
Symptoms: Arthralgia, Asthenia, Decreased appetite, Headache, Myalgia
Clinical narrative: I hurt so bad and had such a severe headache and I hurt all over, high fever, I did not want to eat for 2 days. I was extremely weak. I haven't been sick in almost 10 years. I slept for a whole day, it was like I was unconscious. I had such a horrible painful headache. I got up today and got dressed to go to the bank and was just too weak to go. Muscle and joint pain in every single muscle and joint!
Age: 74.0
Sex: F
Vaccine: RSV
Symptoms: Pain, Pyrexia, Somnolence
Clinical narrative: I hurt so bad and had such a severe headache and I hurt all over, high fever, I did not want to eat for 2 days. I was extremely weak. I haven't been sick in almost 10 years. I slept for a whole day, it was like I was unconscious. I had such a horrible painful headache. I got up today and got dressed to go to the bank and was just too weak to go. Muscle and joint pain in every single muscle and joint!
Age: 62.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19
Clinical narrative: Hospitalized with Covid
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19
Clinical narrative: hospitalized with COVID
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19
Clinical narrative: Hospitalized for covid
Age: 64.0
Sex: F
Vaccine: RSV
Symptoms: Atrial fibrillation, Condition aggravated
Clinical narrative: Pt called stating that after receiving the vaccine they have been experiencing more episodes of Afib than prior. Now episodes are occurring nightly. Patient advised to let her doctor know as well
Age: 57.0
Sex: F
Vaccine: COVID19
Symptoms: Arthralgia, Decreased appetite, Diarrhoea, Disability, Headache
Clinical narrative: The muscle and joint pain the next 2 days were debilitating.  It was hard to move.  I had a constant headache and fever.  The fever ended by afternoon of 12/17.    I had diahria and loss of appetite.    I never had this kind of reaction to my other COVID vacs.
Age: 57.0
Sex: F
Vaccine: COVID19
Symptoms: Mobility decreased, Myalgia, Pyrexia
Clinical narrative: The muscle and joint pain the next 2 days were debilitating.  It was hard to move.  I had a constant headache and fever.  The fever ended by afternoon of 12/17.    I had diahria and loss of appetite.    I never had this kind of reaction to my other COVID vacs.
Age: 73.0
Sex: F
Vaccine: RSV
Symptoms: Pain in extremity
Clinical narrative: PATIENT STARTED TO EXPERINECE AN ARM ACHE 5 DAYS AFTER VACCINATION
Age: 72.0
Sex: F
Vaccine: COVID19-2
Symptoms: Injection site erythema, Injection site pruritus
Clinical narrative: Per patient, she began to experience injection site itching on the same day of injection. Patient states her injection site is still red.
Age: 48.0
Sex: F
Vaccine: FLU4
Symptoms: Arthralgia, Product administered at inappropriate site
Clinical narrative: Injection given very high on the arm.  Pain in shoulder joint continues after 7 weeks.
Age: 59.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Cough, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test
Clinical narrative: Sore throat, cough, congestion
Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Dermatitis atopic, Haemorrhage, Pruritus, Rash, Skin atrophy
Clinical narrative: Patient reported that he had never had Atopic dermatitis prior to getting the second vaccine of Covid-19 about 2 years ago. He stated he first received Moderna and then received Pfizer vaccine. He stated he developed  rashes on the back of the arms and legs which then moved to and settled into a terrible rash on his back. He stated he lost 60 pounds (from 220 to 160 pounds and now is back to 205lbs) and has been using Dupixent to alleviate his atopic dermatitis. He reports he gets an occasional itch on his back and that the skin on his forearms isn't as thick as it used to be and will sometimes bleed if bumped or scratched
Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Weight decreased
Clinical narrative: Patient reported that he had never had Atopic dermatitis prior to getting the second vaccine of Covid-19 about 2 years ago. He stated he first received Moderna and then received Pfizer vaccine. He stated he developed  rashes on the back of the arms and legs which then moved to and settled into a terrible rash on his back. He stated he lost 60 pounds (from 220 to 160 pounds and now is back to 205lbs) and has been using Dupixent to alleviate his atopic dermatitis. He reports he gets an occasional itch on his back and that the skin on his forearms isn't as thick as it used to be and will sometimes bleed if bumped or scratched
Age: 62.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19-2
Symptoms: Chills, Cough, Dyspnoea, Pain, Pyrexia
Clinical narrative: Fever, shills, aching, cough, shortness of breath beginning 12/20/2023
Age: 62.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19-2
Symptoms: SARS-CoV-2 test
Clinical narrative: Fever, shills, aching, cough, shortness of breath beginning 12/20/2023
Age: 68.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Cough, Headache, Pain, SARS-CoV-2 test
Clinical narrative: Cough, headache, body aches
Age: 51.0
Sex: M
Vaccine: VARZOS
Symptoms: Product storage error
Clinical narrative: VACCINE FROZEN INSTEAD OF REFRIGERATED
Age: 4.0
Sex: M
Vaccine: HIBV
Symptoms: No adverse event, Product preparation error
Clinical narrative: Employee administered saline diluent 0.4% sodium chloride to patient without reconstituting with powdered content. Patient did not experience any adverse side effects.
Age: 52.0
Sex: M
Vaccine: VARZOS
Symptoms: Product storage error
Clinical narrative: VACCINE FROZEN INSTEAD OF REFRIGERATED
Age: 53.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Cough, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test
Clinical narrative: Nasal congestion, sore throat, mild dry cough
Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Blood thyroid stimulating hormone increased, Brain fog, Chest pain, Confusional state, Decreased appetite
Clinical narrative: Ongoing events Cardiovascular - Tachycardia; elevated heart rate day and night; throbbing in arms, chest, neck, and head with each heartbeat; feeling that my heart is working hard, even when the pulse rate and blood pressure are normal. Neurological - Tingling in face and scalp; headaches; feeling lightheaded; brain fog (now resolved); short-term memory issues and confusion (now resolved); loss of appetite (now resolved). Hormonal - Elevated TSH. Short-term events - all resolved Fatigue, muscle aches; muscle trembling/spasming; extreme thirst; reduced bladder control.
Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Dizziness, Fatigue, Headache, Memory impairment, Muscle spasms
Clinical narrative: Ongoing events Cardiovascular - Tachycardia; elevated heart rate day and night; throbbing in arms, chest, neck, and head with each heartbeat; feeling that my heart is working hard, even when the pulse rate and blood pressure are normal. Neurological - Tingling in face and scalp; headaches; feeling lightheaded; brain fog (now resolved); short-term memory issues and confusion (now resolved); loss of appetite (now resolved). Hormonal - Elevated TSH. Short-term events - all resolved Fatigue, muscle aches; muscle trembling/spasming; extreme thirst; reduced bladder control.
Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Myalgia, Neck pain, Pain in extremity, Paraesthesia, Tachycardia
Clinical narrative: Ongoing events Cardiovascular - Tachycardia; elevated heart rate day and night; throbbing in arms, chest, neck, and head with each heartbeat; feeling that my heart is working hard, even when the pulse rate and blood pressure are normal. Neurological - Tingling in face and scalp; headaches; feeling lightheaded; brain fog (now resolved); short-term memory issues and confusion (now resolved); loss of appetite (now resolved). Hormonal - Elevated TSH. Short-term events - all resolved Fatigue, muscle aches; muscle trembling/spasming; extreme thirst; reduced bladder control.
Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Thirst, Tremor, Urinary incontinence
Clinical narrative: Ongoing events Cardiovascular - Tachycardia; elevated heart rate day and night; throbbing in arms, chest, neck, and head with each heartbeat; feeling that my heart is working hard, even when the pulse rate and blood pressure are normal. Neurological - Tingling in face and scalp; headaches; feeling lightheaded; brain fog (now resolved); short-term memory issues and confusion (now resolved); loss of appetite (now resolved). Hormonal - Elevated TSH. Short-term events - all resolved Fatigue, muscle aches; muscle trembling/spasming; extreme thirst; reduced bladder control.
Age: 16.0
Sex: M
Vaccine: MNQ
Symptoms: Extra dose administered, No adverse event
Clinical narrative: Gave a third dose of Mennquafi / no reactions were reported / Pt was notified
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Urticaria
Clinical narrative: Patient received COMIRNATY 2023-24 (12y up) vaccine by pfizer on 12/16/2023. Patient started getting hives the next day, first in the arm that she recieved the injection and then all over. Pt states she still has hives as of 12/26/2023
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Chest X-ray abnormal, Confusional state, Dyspnoea, Muscular weakness
Clinical narrative: Patient is a 72 y.o. female patient of MD with history of chronic pain syndrome, hypertension, smoker presented to Hospital with leg weakness confusion shortness of breath.   Leg weakness confusion shortness of breath COVID-positive Supportive care Pain management S/p Decadron Dc  ceftriaxone azithromycin Continue O2 support, wean as tolerated ID consult   Acute confusion secondary to COVID  POA , resolved Covid-19 Virus Infection Date of onset of symptoms: 10/24/2023 Symptoms present on admission: Yes Date of covid positive test: 10/26/2023 Vaccination status: vaccinated does not remember how many time Imaging: X-ray volume congestion Oxygen requirements on admission: Yes Current oxygen requirements: none S/p  steroids, and remdesivir Consultants following: ID Anticipated special isolation end date: 11/4/2023     Hypertension Continue Norvasc   H/o Infrarenal aortic aneursym Denies any complaints Appreciate vascular surgery input S/p abdominal aorta duplex shows that the aneurysm was 4.3 x 4.2 cm, f/u with vascular in one year
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Pulmonary congestion, SARS-CoV-2 test positive, Ultrasound abdomen
Clinical narrative: Patient is a 72 y.o. female patient of MD with history of chronic pain syndrome, hypertension, smoker presented to Hospital with leg weakness confusion shortness of breath.   Leg weakness confusion shortness of breath COVID-positive Supportive care Pain management S/p Decadron Dc  ceftriaxone azithromycin Continue O2 support, wean as tolerated ID consult   Acute confusion secondary to COVID  POA , resolved Covid-19 Virus Infection Date of onset of symptoms: 10/24/2023 Symptoms present on admission: Yes Date of covid positive test: 10/26/2023 Vaccination status: vaccinated does not remember how many time Imaging: X-ray volume congestion Oxygen requirements on admission: Yes Current oxygen requirements: none S/p  steroids, and remdesivir Consultants following: ID Anticipated special isolation end date: 11/4/2023     Hypertension Continue Norvasc   H/o Infrarenal aortic aneursym Denies any complaints Appreciate vascular surgery input S/p abdominal aorta duplex shows that the aneurysm was 4.3 x 4.2 cm, f/u with vascular in one year
Age: 16.0
Sex: M
Vaccine: HPV9, MNQ
Symptoms: No adverse event
Clinical narrative: Patient was observed 15-20 mins after vaccine administration.  No acute adverse symptoms noticed while at the healthcare faciliity.
Age: 16.0
Sex: M
Vaccine: MNQ
Symptoms: Urticaria
Clinical narrative: hives on legs and arms and trunk developed 5 days later. responded to benadryl and later zyrtec but persisted for about a week. worsened by increased body temperature
Age: 62.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute kidney injury, Blood creatinine increased, COVID-19, Chest X-ray abnormal, Cough
Clinical narrative: Patient is a 63 y.o. male patient of No, Physician with history of leukemia, in remission with last chemotherapy, anxiety, arthritis, GERD, dyslipidemia, hypertension, obesity presented to Hospital with cough, congestion, SOB, fever      COVID-19 infection Patient presented with fever, cough CXR negative for consolidation or infiltrate.  Small amount of pleural fluid at the left costophrenic angle Last echo done on 9/23 showed normal LVEF 60%, no PTH  Monitor respiratory status, keep SPO2 above 94% Start dexamethasone IV 6 mg daily Follow-up CMP, No need for antibiotic at this time Supportive treatment   Seen by ID  patient started on Paxlovid    AKI Creatinine admission 1.68 Avoid nephrotoxic agent Gentle IV hydration     Hypertension Continue lisinopril hydrochlorothiazide 20 mg?12.5   Dyslipidemia Continue fenofibrate   GERD Continue Pepcid   Anxiety Continue Seroquel 25 mg daily   Leukemia In remission, follow-up CBC daily   BPH Continue finasteride and tamsulosin
Age: 62.0
Sex: M
Vaccine: COVID19-2
Symptoms: Dyspnoea, Echocardiogram normal, Ejection fraction, Pleural effusion, Pyrexia
Clinical narrative: Patient is a 63 y.o. male patient of No, Physician with history of leukemia, in remission with last chemotherapy, anxiety, arthritis, GERD, dyslipidemia, hypertension, obesity presented to Hospital with cough, congestion, SOB, fever      COVID-19 infection Patient presented with fever, cough CXR negative for consolidation or infiltrate.  Small amount of pleural fluid at the left costophrenic angle Last echo done on 9/23 showed normal LVEF 60%, no PTH  Monitor respiratory status, keep SPO2 above 94% Start dexamethasone IV 6 mg daily Follow-up CMP, No need for antibiotic at this time Supportive treatment   Seen by ID  patient started on Paxlovid    AKI Creatinine admission 1.68 Avoid nephrotoxic agent Gentle IV hydration     Hypertension Continue lisinopril hydrochlorothiazide 20 mg?12.5   Dyslipidemia Continue fenofibrate   GERD Continue Pepcid   Anxiety Continue Seroquel 25 mg daily   Leukemia In remission, follow-up CBC daily   BPH Continue finasteride and tamsulosin
Age: 62.0
Sex: M
Vaccine: COVID19-2
Symptoms: Respiratory tract congestion
Clinical narrative: Patient is a 63 y.o. male patient of No, Physician with history of leukemia, in remission with last chemotherapy, anxiety, arthritis, GERD, dyslipidemia, hypertension, obesity presented to Hospital with cough, congestion, SOB, fever      COVID-19 infection Patient presented with fever, cough CXR negative for consolidation or infiltrate.  Small amount of pleural fluid at the left costophrenic angle Last echo done on 9/23 showed normal LVEF 60%, no PTH  Monitor respiratory status, keep SPO2 above 94% Start dexamethasone IV 6 mg daily Follow-up CMP, No need for antibiotic at this time Supportive treatment   Seen by ID  patient started on Paxlovid    AKI Creatinine admission 1.68 Avoid nephrotoxic agent Gentle IV hydration     Hypertension Continue lisinopril hydrochlorothiazide 20 mg?12.5   Dyslipidemia Continue fenofibrate   GERD Continue Pepcid   Anxiety Continue Seroquel 25 mg daily   Leukemia In remission, follow-up CBC daily   BPH Continue finasteride and tamsulosin
Age: 67.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Cough, Oropharyngeal pain
Clinical narrative: Sore throat, mild dry cough
Age: 72.0
Sex: F
Vaccine: RSV
Symptoms: Diarrhoea, Headache, Hyperhidrosis, Malaise, Pain in extremity
Clinical narrative: bad headache, excessive sweating, diarrhea, and sore arm
Age: 70.0
Sex: M
Vaccine: COVID19-2
Symptoms: Asthenia, Blood lactic acid increased, COVID-19, Cerebral atrophy, Cerebral small vessel ischaemic disease
Clinical narrative: Patient is a 71 y.o. male with a history of T2DM, HTN, depression, who presented to hospital on 10/16/2023 for nausea/vomiting, severe generalized weakness. Found COVID+ without respiratory distress or hypoxia, symptoms improved with supportive care and Paxlovid initiated given high-risk with age/co-morbidities.   1. COVID-19 infection: Test positive 10/16/23, with symptoms starting 10/14/23. High-risk with age and co-morbidities. Last bivalent booster 12/2022. Not hypoxic. CXR on admit without significant infiltrates. ID followed via e-consult: recommended Paxlovid course initiated 10/17/23 (held atorvastatin for now, restart when Paxlovid complete). Rest of course prescribed at discharge. 2. Nausea/vomiting: Suspect related to COVID infection as reportedly similar to prior presentation in 2020. Gastroparesis could be considered. Improved with PRN anti-emetics and supportive care. Tolerated diet prior to discharge.  3. Generalized weakness: Likely due to COVID and poor PO. PT/OT evaluated. 4. Lactic acidosis: Lactate 2.7 on admit. Suspect from hypovolemia due to N/V. Resolved. 5. T2DM: Last A1C 7.5% in 7/2023. Home regimen Lantus alone at 50 units at bedtime. Continued reduced basal dose while acutely ill with poor PO intake, plus SSI. Back to home regimen at discharge with reduced basal insulin dosing until back to regular PO intake.  6. HTN: Reports on home amlodipine, lisinopril, Toprol (fill history without amlodipine or lisinopril). Continued home meds.  7. Peripheral neuropathy: Suspected due to diabetes. Saw Neuro 8/29/23, felt that neuropathy was contributing to his ongoing gait imbalance. 8. Cognitive impairment: Recently also saw Neuro for memory issues. MRI brain 9/2/2023 showed global cerebral volume loss, chronic microvascular changes. Pending outpatient Neuropsych eval.