chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 89.0
Sex: F
Vaccine: COVID19
Symptoms: Haemoglobin decreased, Lung opacity, Malaise, Normocytic anaemia, Prohormone brain natriuretic peptide increased
Clinical narrative: The patient is a 90 y.o. female with a history of PE/DVT 6/2022 completed 3 months of Xarelto, Hypertension, Hyperlipidemia, GERD, Ulcerative colitis, Anemia, Arthritis, admitted with COVID-19 and generalized weakness. When she progressed, she was discharged HHC in stable but guarded condition with advice for all time fall precautions and OP f/u with her physicians as instructed.   Acute respiratory failure with hypoxia-resolved Covid-19 Virus Infection Date of onset of symptoms: 10/17/2022 Symptoms present on admission: Cough, dyspnea, rhinorrhea, loss of taste/smell, nausea, fever/chills Date of covid positive test: 10/18/2022 Vaccination status: vaccinated, f/u with PCP for need for booster in near future Imaging: CTPA negative for PE, revealed bilateral bronchial wall thickening and scattered bilateral lung opacities Oxygen requirements on admission: 2 L Current oxygen requirements: RA Medical therapy: remdesivir and steroids(Day #4), resume home prednisone taper on discharge Consultants following: None Anticipated special isolation end date: 10/29/2022 Weaned to RA and did not need home o2 on discharge Cough better OP PCP f/u as instructed     SIRS criteria- improved WBC 12.31, tachycardia Likely secondary to COVID-19 Blood cultures-NGTD.  LA normal     New onset atrial fibrillation with RVR, prozsymal Converted to NSR following 10 mg IV Cardizem in ED proBNP 613.  TSH normal.  Serial troponins with a flat trend 21> 21 Echo from June 2022 with EF greater than 70% RVSP 42 mmHg, moderate TR Cardiology followed in the hospital Continue home Rx Toprol-XL 25 mg daily Cardiology started AC with Xarelto 15 mg daily OP Cardio f/u as instructed   Chronic normocytic anemia Baseline hemoglobin 9.7 to 11 g/dL H&H 9.9/31.7 OP PCP f/u    Generalized weakness Up with assistance PT/OT evaluated-recommended home therapy and qualified for HHC on discharge C/w wheeled walker and all time fall precautions  Essential hypertension ontinue Toprol and hydrochlorothiazide   Ulcerative colitis Started on prednisone taper 10/1-will held while receiving Decadron>resume on discharge Continue Entocort Pepcid for a month ordered OP PCP f/u recommended   History of recent PE Saddle PE with extensive bilateral emboli with heart strain in June 2022 Completed 3 months of Xarelto Admission CTPA with no evidence of PE
Age: 89.0
Sex: F
Vaccine: COVID19
Symptoms: Pulmonary embolism, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive, Tachycardia
Clinical narrative: The patient is a 90 y.o. female with a history of PE/DVT 6/2022 completed 3 months of Xarelto, Hypertension, Hyperlipidemia, GERD, Ulcerative colitis, Anemia, Arthritis, admitted with COVID-19 and generalized weakness. When she progressed, she was discharged HHC in stable but guarded condition with advice for all time fall precautions and OP f/u with her physicians as instructed.   Acute respiratory failure with hypoxia-resolved Covid-19 Virus Infection Date of onset of symptoms: 10/17/2022 Symptoms present on admission: Cough, dyspnea, rhinorrhea, loss of taste/smell, nausea, fever/chills Date of covid positive test: 10/18/2022 Vaccination status: vaccinated, f/u with PCP for need for booster in near future Imaging: CTPA negative for PE, revealed bilateral bronchial wall thickening and scattered bilateral lung opacities Oxygen requirements on admission: 2 L Current oxygen requirements: RA Medical therapy: remdesivir and steroids(Day #4), resume home prednisone taper on discharge Consultants following: None Anticipated special isolation end date: 10/29/2022 Weaned to RA and did not need home o2 on discharge Cough better OP PCP f/u as instructed     SIRS criteria- improved WBC 12.31, tachycardia Likely secondary to COVID-19 Blood cultures-NGTD.  LA normal     New onset atrial fibrillation with RVR, prozsymal Converted to NSR following 10 mg IV Cardizem in ED proBNP 613.  TSH normal.  Serial troponins with a flat trend 21> 21 Echo from June 2022 with EF greater than 70% RVSP 42 mmHg, moderate TR Cardiology followed in the hospital Continue home Rx Toprol-XL 25 mg daily Cardiology started AC with Xarelto 15 mg daily OP Cardio f/u as instructed   Chronic normocytic anemia Baseline hemoglobin 9.7 to 11 g/dL H&H 9.9/31.7 OP PCP f/u    Generalized weakness Up with assistance PT/OT evaluated-recommended home therapy and qualified for HHC on discharge C/w wheeled walker and all time fall precautions  Essential hypertension ontinue Toprol and hydrochlorothiazide   Ulcerative colitis Started on prednisone taper 10/1-will held while receiving Decadron>resume on discharge Continue Entocort Pepcid for a month ordered OP PCP f/u recommended   History of recent PE Saddle PE with extensive bilateral emboli with heart strain in June 2022 Completed 3 months of Xarelto Admission CTPA with no evidence of PE
Age: 89.0
Sex: F
Vaccine: COVID19
Symptoms: Troponin, White blood cell count increased
Clinical narrative: The patient is a 90 y.o. female with a history of PE/DVT 6/2022 completed 3 months of Xarelto, Hypertension, Hyperlipidemia, GERD, Ulcerative colitis, Anemia, Arthritis, admitted with COVID-19 and generalized weakness. When she progressed, she was discharged HHC in stable but guarded condition with advice for all time fall precautions and OP f/u with her physicians as instructed.   Acute respiratory failure with hypoxia-resolved Covid-19 Virus Infection Date of onset of symptoms: 10/17/2022 Symptoms present on admission: Cough, dyspnea, rhinorrhea, loss of taste/smell, nausea, fever/chills Date of covid positive test: 10/18/2022 Vaccination status: vaccinated, f/u with PCP for need for booster in near future Imaging: CTPA negative for PE, revealed bilateral bronchial wall thickening and scattered bilateral lung opacities Oxygen requirements on admission: 2 L Current oxygen requirements: RA Medical therapy: remdesivir and steroids(Day #4), resume home prednisone taper on discharge Consultants following: None Anticipated special isolation end date: 10/29/2022 Weaned to RA and did not need home o2 on discharge Cough better OP PCP f/u as instructed     SIRS criteria- improved WBC 12.31, tachycardia Likely secondary to COVID-19 Blood cultures-NGTD.  LA normal     New onset atrial fibrillation with RVR, prozsymal Converted to NSR following 10 mg IV Cardizem in ED proBNP 613.  TSH normal.  Serial troponins with a flat trend 21> 21 Echo from June 2022 with EF greater than 70% RVSP 42 mmHg, moderate TR Cardiology followed in the hospital Continue home Rx Toprol-XL 25 mg daily Cardiology started AC with Xarelto 15 mg daily OP Cardio f/u as instructed   Chronic normocytic anemia Baseline hemoglobin 9.7 to 11 g/dL H&H 9.9/31.7 OP PCP f/u    Generalized weakness Up with assistance PT/OT evaluated-recommended home therapy and qualified for HHC on discharge C/w wheeled walker and all time fall precautions  Essential hypertension ontinue Toprol and hydrochlorothiazide   Ulcerative colitis Started on prednisone taper 10/1-will held while receiving Decadron>resume on discharge Continue Entocort Pepcid for a month ordered OP PCP f/u recommended   History of recent PE Saddle PE with extensive bilateral emboli with heart strain in June 2022 Completed 3 months of Xarelto Admission CTPA with no evidence of PE
Age: 33.0
Sex: F
Vaccine: COVID19
Symptoms: Lichen planus
Clinical narrative: I was diagnosed with Lichen Planus, a autoimmune related skin disorder that I never had before.
Age: 63.0
Sex: M
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: peds dose administer to an adult pt
Age: 52.0
Sex: F
Vaccine: COVID19
Symptoms: Haemorrhage, Pruritus, Rash, Scratch, Urticaria
Clinical narrative: 2 hours after vaccine had itchy legs and thought a rash. It has now been 2 days and is traveling upward (to thighs and waist) and is more like hives. Extremely itchy and scratching until I bleed.
Age: 3.0
Sex: F
Vaccine: COVID19
Symptoms: Diarrhoea
Clinical narrative: Diarrhea after vaccine
Age: 93.0
Sex: F
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: peds dose administer to an adult pt
Age: 69.0
Sex: F
Vaccine: COVID19-2
Symptoms: Tinnitus
Clinical narrative: Tinnitus
Age: 11.0
Sex: F
Vaccine: COVID19-2
Symptoms: Incorrect dose administered
Clinical narrative: Pt received adult 12+ Pfizer bivalent instead of Peds Pfizer 5-11 bivalent
Age: 51.0
Sex: M
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: peds dose administer to an adult pt
Age: 64.0
Sex: F
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: peds dose administer to an adult pt
Age: 39.0
Sex: M
Vaccine: UNK
Symptoms: Needle issue
Clinical narrative: I injected a needle into a patient that was connected to the Fluzone HD flu vaccine. I realized that was the incorrect vaccine and I did not administer the vaccine and I removed the needle. The patient did not actually receive the incorrect vaccine but I did put the needle into his arm. I then administer the age appropriate flu vaccine.
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Alanine aminotransferase increased, Angiogram pulmonary, Aspartate aminotransferase increased, Asymptomatic bacteriuria
Clinical narrative: The patient is a 70 y.o. female with history of anxiety, hyperlipidemia, presented to the Hospital with shortness of breath, nausea.   Covid-19 Virus Infection Acute respiratory failure with hypoxia  Date of onset of symptoms: 11/1 Symptoms present on admission: Cough, shortness of breath, nausea Date of covid positive test: 11/3 Vaccination status: vaccinated Imaging: CTPA nonacute Oxygen requirements on admission: 2 L/min Current oxygen requirements: Oxygen saturation 93% on 1 L nasal cannula.  Medical therapy: steroids Consultants following: N/A Anticipated special isolation end date: 11/12  Patient set up with home O2.   Lactic acidosis Dehydration Suspect secondary to COVID and dehydration Initial lactic acid peaked at 3.3, resolved   Transaminasemia Likely secondary to COVID Denies abdominal pain Initial elevation AST 198, ALT 303, alk phos 170 up from previously normal prior to admission  Tylenol level, negative hepatitis panel WNL Abdominal ultrasound  showed mild geographic areas of fatty infiltration within the liver and some gallbladder sludge. Held Tylenol and statin GGT elevated at 280 MRCP showed no suspicious common duct stricture or filling defect. No intrahepatic biliary dilatation. Liver normal in contour and morphology. Follow-up with PCP   Anxiety Continue Wellbutrin and Valium.       Hyperlipidemia Continue statin  Marijuana use Patient smokes/vapes 2-3 times daily Encourage cessation   Asymptomatic bacteriuria Urine culture 11/3 grew E. Coli Patient is complaining of urinary symptoms Continue to monitor and treat if she becomes symptomatic
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Blood alkaline phosphatase increased, Blood lactic acid increased, COVID-19, Cholelithiasis, Cough
Clinical narrative: The patient is a 70 y.o. female with history of anxiety, hyperlipidemia, presented to the Hospital with shortness of breath, nausea.   Covid-19 Virus Infection Acute respiratory failure with hypoxia  Date of onset of symptoms: 11/1 Symptoms present on admission: Cough, shortness of breath, nausea Date of covid positive test: 11/3 Vaccination status: vaccinated Imaging: CTPA nonacute Oxygen requirements on admission: 2 L/min Current oxygen requirements: Oxygen saturation 93% on 1 L nasal cannula.  Medical therapy: steroids Consultants following: N/A Anticipated special isolation end date: 11/12  Patient set up with home O2.   Lactic acidosis Dehydration Suspect secondary to COVID and dehydration Initial lactic acid peaked at 3.3, resolved   Transaminasemia Likely secondary to COVID Denies abdominal pain Initial elevation AST 198, ALT 303, alk phos 170 up from previously normal prior to admission  Tylenol level, negative hepatitis panel WNL Abdominal ultrasound  showed mild geographic areas of fatty infiltration within the liver and some gallbladder sludge. Held Tylenol and statin GGT elevated at 280 MRCP showed no suspicious common duct stricture or filling defect. No intrahepatic biliary dilatation. Liver normal in contour and morphology. Follow-up with PCP   Anxiety Continue Wellbutrin and Valium.       Hyperlipidemia Continue statin  Marijuana use Patient smokes/vapes 2-3 times daily Encourage cessation   Asymptomatic bacteriuria Urine culture 11/3 grew E. Coli Patient is complaining of urinary symptoms Continue to monitor and treat if she becomes symptomatic
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Culture urine positive, Dehydration, Dyspnoea, Escherichia test positive, Gamma-glutamyltransferase increased
Clinical narrative: The patient is a 70 y.o. female with history of anxiety, hyperlipidemia, presented to the Hospital with shortness of breath, nausea.   Covid-19 Virus Infection Acute respiratory failure with hypoxia  Date of onset of symptoms: 11/1 Symptoms present on admission: Cough, shortness of breath, nausea Date of covid positive test: 11/3 Vaccination status: vaccinated Imaging: CTPA nonacute Oxygen requirements on admission: 2 L/min Current oxygen requirements: Oxygen saturation 93% on 1 L nasal cannula.  Medical therapy: steroids Consultants following: N/A Anticipated special isolation end date: 11/12  Patient set up with home O2.   Lactic acidosis Dehydration Suspect secondary to COVID and dehydration Initial lactic acid peaked at 3.3, resolved   Transaminasemia Likely secondary to COVID Denies abdominal pain Initial elevation AST 198, ALT 303, alk phos 170 up from previously normal prior to admission  Tylenol level, negative hepatitis panel WNL Abdominal ultrasound  showed mild geographic areas of fatty infiltration within the liver and some gallbladder sludge. Held Tylenol and statin GGT elevated at 280 MRCP showed no suspicious common duct stricture or filling defect. No intrahepatic biliary dilatation. Liver normal in contour and morphology. Follow-up with PCP   Anxiety Continue Wellbutrin and Valium.       Hyperlipidemia Continue statin  Marijuana use Patient smokes/vapes 2-3 times daily Encourage cessation   Asymptomatic bacteriuria Urine culture 11/3 grew E. Coli Patient is complaining of urinary symptoms Continue to monitor and treat if she becomes symptomatic
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Hepatic steatosis, Hepatitis viral test negative, Lactic acidosis, Lower urinary tract symptoms, Magnetic resonance cholangiopancreatography
Clinical narrative: The patient is a 70 y.o. female with history of anxiety, hyperlipidemia, presented to the Hospital with shortness of breath, nausea.   Covid-19 Virus Infection Acute respiratory failure with hypoxia  Date of onset of symptoms: 11/1 Symptoms present on admission: Cough, shortness of breath, nausea Date of covid positive test: 11/3 Vaccination status: vaccinated Imaging: CTPA nonacute Oxygen requirements on admission: 2 L/min Current oxygen requirements: Oxygen saturation 93% on 1 L nasal cannula.  Medical therapy: steroids Consultants following: N/A Anticipated special isolation end date: 11/12  Patient set up with home O2.   Lactic acidosis Dehydration Suspect secondary to COVID and dehydration Initial lactic acid peaked at 3.3, resolved   Transaminasemia Likely secondary to COVID Denies abdominal pain Initial elevation AST 198, ALT 303, alk phos 170 up from previously normal prior to admission  Tylenol level, negative hepatitis panel WNL Abdominal ultrasound  showed mild geographic areas of fatty infiltration within the liver and some gallbladder sludge. Held Tylenol and statin GGT elevated at 280 MRCP showed no suspicious common duct stricture or filling defect. No intrahepatic biliary dilatation. Liver normal in contour and morphology. Follow-up with PCP   Anxiety Continue Wellbutrin and Valium.       Hyperlipidemia Continue statin  Marijuana use Patient smokes/vapes 2-3 times daily Encourage cessation   Asymptomatic bacteriuria Urine culture 11/3 grew E. Coli Patient is complaining of urinary symptoms Continue to monitor and treat if she becomes symptomatic
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Nausea, SARS-CoV-2 test positive, Ultrasound abdomen abnormal
Clinical narrative: The patient is a 70 y.o. female with history of anxiety, hyperlipidemia, presented to the Hospital with shortness of breath, nausea.   Covid-19 Virus Infection Acute respiratory failure with hypoxia  Date of onset of symptoms: 11/1 Symptoms present on admission: Cough, shortness of breath, nausea Date of covid positive test: 11/3 Vaccination status: vaccinated Imaging: CTPA nonacute Oxygen requirements on admission: 2 L/min Current oxygen requirements: Oxygen saturation 93% on 1 L nasal cannula.  Medical therapy: steroids Consultants following: N/A Anticipated special isolation end date: 11/12  Patient set up with home O2.   Lactic acidosis Dehydration Suspect secondary to COVID and dehydration Initial lactic acid peaked at 3.3, resolved   Transaminasemia Likely secondary to COVID Denies abdominal pain Initial elevation AST 198, ALT 303, alk phos 170 up from previously normal prior to admission  Tylenol level, negative hepatitis panel WNL Abdominal ultrasound  showed mild geographic areas of fatty infiltration within the liver and some gallbladder sludge. Held Tylenol and statin GGT elevated at 280 MRCP showed no suspicious common duct stricture or filling defect. No intrahepatic biliary dilatation. Liver normal in contour and morphology. Follow-up with PCP   Anxiety Continue Wellbutrin and Valium.       Hyperlipidemia Continue statin  Marijuana use Patient smokes/vapes 2-3 times daily Encourage cessation   Asymptomatic bacteriuria Urine culture 11/3 grew E. Coli Patient is complaining of urinary symptoms Continue to monitor and treat if she becomes symptomatic
Age: 56.0
Sex: M
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: peds dose administer to an adult pt
Age: 65.0
Sex: F
Vaccine: PPV
Symptoms: Injection site erythema, Injection site pain, Insomnia
Clinical narrative: PATIENT STATED THAT STARTING THE DAY AFTER VACCINATION (11/17/22) THAT SHE STARTED TO HAVE PAIN AND REDNESS AROUND INJECTION SITE. PATIENT STATED THAT PAIN WORSENED OVERNIGHT AND THAT SHE HAD TROUBLE SLEEPING DUE TO PAIN. WHEN PATIENT PRESENTED TO THE PHARMACY PHARMACIST WAS ABLE TO OBSERVE THAT REDNESS WAS 5-6 CM AROUND AND OVAL SHAPED (ELONGATED UP AND DOWN ARM).
Age: 77.0
Sex: M
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: peds dose administer to an adult pt
Age: 34.0
Sex: F
Vaccine: COVID19
Symptoms: Aldolase, Anti-aquaporin-4 antibody, Antinuclear antibody, Areflexia, Blood 25-hydroxycholecalciferol
Clinical narrative: Severe lower extremity weakness resulting in multiple falls, loss of popliteal reflexes bilaterally, numbness and tingling of bilateral hands, dizziness. Ongoing symptoms still, 20 months post vaccine.
Age: 34.0
Sex: F
Vaccine: COVID19
Symptoms: Blood creatine phosphokinase, Blood test, Borrelia test, Dizziness, Electrophoresis protein
Clinical narrative: Severe lower extremity weakness resulting in multiple falls, loss of popliteal reflexes bilaterally, numbness and tingling of bilateral hands, dizziness. Ongoing symptoms still, 20 months post vaccine.
Age: 34.0
Sex: F
Vaccine: COVID19
Symptoms: Fall, Full blood count, Hypoaesthesia, Laboratory test, Magnetic resonance imaging head
Clinical narrative: Severe lower extremity weakness resulting in multiple falls, loss of popliteal reflexes bilaterally, numbness and tingling of bilateral hands, dizziness. Ongoing symptoms still, 20 months post vaccine.
Age: 34.0
Sex: F
Vaccine: COVID19
Symptoms: Magnetic resonance imaging spinal, Metabolic function test, Mononucleosis heterophile test, Muscular weakness, Paraesthesia
Clinical narrative: Severe lower extremity weakness resulting in multiple falls, loss of popliteal reflexes bilaterally, numbness and tingling of bilateral hands, dizziness. Ongoing symptoms still, 20 months post vaccine.
Age: 34.0
Sex: F
Vaccine: COVID19
Symptoms: Red blood cell sedimentation rate, Rheumatoid factor, Scan with contrast, Vitamin B1, Vitamin B12
Clinical narrative: Severe lower extremity weakness resulting in multiple falls, loss of popliteal reflexes bilaterally, numbness and tingling of bilateral hands, dizziness. Ongoing symptoms still, 20 months post vaccine.
Age: 34.0
Sex: F
Vaccine: COVID19
Symptoms: Vitamin B6
Clinical narrative: Severe lower extremity weakness resulting in multiple falls, loss of popliteal reflexes bilaterally, numbness and tingling of bilateral hands, dizziness. Ongoing symptoms still, 20 months post vaccine.
Age: 78.0
Sex: M
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: peds dose administer to an adult pt
Age: 43.0
Sex: F
Vaccine: FLUC4
Symptoms: Herpes zoster, Rash
Clinical narrative: Developed shingles 6 days post vaccination.  Painful rash on the right side of the back, above waist line.   Treatment:  Valacyclovir (Valrex) Omeprasol ( Prilosec) Prednisone (Deltasone) Betamethasone augmented (Diprolene AF)
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, COVID-19 pneumonia, Central venous catheterisation, Cognitive disorder, Condition aggravated
Clinical narrative: Clinical Summary Hospital Course:    Patient is a 88 y.o. male patient of MD with a history of small bowel obstruction was transferred to a HCF on 11-2-2022.  I saw and evaluated patient in the emergency department and subsequently recommended a laparotomy as he had been dealing with a bowel obstruction for approximately 6 to 7 days.  The patient did require open lysis of adhesions and resection of the small intestine with primary anastomosis.  Postoperatively the patient was sent to a general medical floor.  Nasogastric tube was left in place and he was started on TPN as he had already been n.p.o. for a lengthy period of time.  We did keep him on TPN.  He did suffer from intermittent episodes of delirium and pulled at lines and drains.  His PICC line required replacement as well as the nasogastric tube.  The patient had a steady decline from a respiratory as well as to cognitive standpoint.  He began having bowel function on approximately 11-8-2022.  Due to his respiratory concerns a respiratory panel, viral, was checked and he was found to be positive for COVID.  Patient was placed in isolation.  After long discussion with the family they opted to transition the patient to comfort care as they felt that he would not want to continue with aggressive measures.  The patient passed on 11-11-2022.   Discharge Diagnoses:   Small bowel obstruction COVID-19 pneumonia Protein calorie malnutrition  11/2/22 EXPLORATORY LAPAROTOMY, POSSIBLE BOWEL RESECTION, POSSIBLE OSTOMY
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Death, Delirium, Explorative laparotomy, Gastrointestinal tube insertion, Intestinal adhesion lysis
Clinical narrative: Clinical Summary Hospital Course:    Patient is a 88 y.o. male patient of MD with a history of small bowel obstruction was transferred to a HCF on 11-2-2022.  I saw and evaluated patient in the emergency department and subsequently recommended a laparotomy as he had been dealing with a bowel obstruction for approximately 6 to 7 days.  The patient did require open lysis of adhesions and resection of the small intestine with primary anastomosis.  Postoperatively the patient was sent to a general medical floor.  Nasogastric tube was left in place and he was started on TPN as he had already been n.p.o. for a lengthy period of time.  We did keep him on TPN.  He did suffer from intermittent episodes of delirium and pulled at lines and drains.  His PICC line required replacement as well as the nasogastric tube.  The patient had a steady decline from a respiratory as well as to cognitive standpoint.  He began having bowel function on approximately 11-8-2022.  Due to his respiratory concerns a respiratory panel, viral, was checked and he was found to be positive for COVID.  Patient was placed in isolation.  After long discussion with the family they opted to transition the patient to comfort care as they felt that he would not want to continue with aggressive measures.  The patient passed on 11-11-2022.   Discharge Diagnoses:   Small bowel obstruction COVID-19 pneumonia Protein calorie malnutrition  11/2/22 EXPLORATORY LAPAROTOMY, POSSIBLE BOWEL RESECTION, POSSIBLE OSTOMY
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Intestinal anastomosis, Malnutrition, Medical device change, Respiratory disorder, Respiratory viral panel
Clinical narrative: Clinical Summary Hospital Course:    Patient is a 88 y.o. male patient of MD with a history of small bowel obstruction was transferred to a HCF on 11-2-2022.  I saw and evaluated patient in the emergency department and subsequently recommended a laparotomy as he had been dealing with a bowel obstruction for approximately 6 to 7 days.  The patient did require open lysis of adhesions and resection of the small intestine with primary anastomosis.  Postoperatively the patient was sent to a general medical floor.  Nasogastric tube was left in place and he was started on TPN as he had already been n.p.o. for a lengthy period of time.  We did keep him on TPN.  He did suffer from intermittent episodes of delirium and pulled at lines and drains.  His PICC line required replacement as well as the nasogastric tube.  The patient had a steady decline from a respiratory as well as to cognitive standpoint.  He began having bowel function on approximately 11-8-2022.  Due to his respiratory concerns a respiratory panel, viral, was checked and he was found to be positive for COVID.  Patient was placed in isolation.  After long discussion with the family they opted to transition the patient to comfort care as they felt that he would not want to continue with aggressive measures.  The patient passed on 11-11-2022.   Discharge Diagnoses:   Small bowel obstruction COVID-19 pneumonia Protein calorie malnutrition  11/2/22 EXPLORATORY LAPAROTOMY, POSSIBLE BOWEL RESECTION, POSSIBLE OSTOMY
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Small intestinal obstruction, Small intestinal resection, Unintentional medical device removal
Clinical narrative: Clinical Summary Hospital Course:    Patient is a 88 y.o. male patient of MD with a history of small bowel obstruction was transferred to a HCF on 11-2-2022.  I saw and evaluated patient in the emergency department and subsequently recommended a laparotomy as he had been dealing with a bowel obstruction for approximately 6 to 7 days.  The patient did require open lysis of adhesions and resection of the small intestine with primary anastomosis.  Postoperatively the patient was sent to a general medical floor.  Nasogastric tube was left in place and he was started on TPN as he had already been n.p.o. for a lengthy period of time.  We did keep him on TPN.  He did suffer from intermittent episodes of delirium and pulled at lines and drains.  His PICC line required replacement as well as the nasogastric tube.  The patient had a steady decline from a respiratory as well as to cognitive standpoint.  He began having bowel function on approximately 11-8-2022.  Due to his respiratory concerns a respiratory panel, viral, was checked and he was found to be positive for COVID.  Patient was placed in isolation.  After long discussion with the family they opted to transition the patient to comfort care as they felt that he would not want to continue with aggressive measures.  The patient passed on 11-11-2022.   Discharge Diagnoses:   Small bowel obstruction COVID-19 pneumonia Protein calorie malnutrition  11/2/22 EXPLORATORY LAPAROTOMY, POSSIBLE BOWEL RESECTION, POSSIBLE OSTOMY
Age: 73.0
Sex: M
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: peds dose administer to an adult pt
Age: 70.0
Sex: M
Vaccine: FLU4
Symptoms: Skin warm, Vaccination site erythema, Vaccination site oedema
Clinical narrative: Patient called to report profuse erythema and edema involving the L. arm where vaccine administered. Pt states hot to the touch. Recommended benadryl, and nsaid. Pt stated did not have any benadryl nor NSAIDs at home and is nonambulatory. Pt is unable to attain ride to urgent care or clinic if necessary. Again recommended to seek urgent consultation with physician/arnp/pa-c for further investigation and resolution if condition continues or worsens.
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Acute myeloid leukaemia, Blood culture negative, Blood potassium decreased, Blood sodium increased, COVID-19
Clinical narrative: Hypernatremia - resolved Hypokalemia - resolved Diabetes insipidus Fatigue BMP on admission shows Na 153, K 2.7 Na 144, K 4.1 11/3 Pt has documented history of diabetes insipidus- follows with Dr with endocrine, treated with DDAVP - Resume home DDAVP - Replace potassium  - Trend BMP - Pt received D5W, now stopped - Encourage PO fluid intake - Endocrine consulted - suggested DI possibly related to AML but unclear etiology - Recommend outpatient follow up with endocrinology   Pancytopenia due to chemotherapy AML Getting chemo, last treatment 10/10/22 Restart pancytopenia prophylaxis, acyclovir, diflucan, levaquin was held while inpt as pt was tx with zosyn, will restart levaquin upon discharge for 5 day course Venetoclax held in setting of pancytopenia, will defer to heme/onc when to restart   Multifocal pneumonia COVID-19 infection Suspect pneumonia likely viral due to COVID Symptoms started 10/29, tested positive on admission, SORA CXR 10/31/22 shows ill defined consolidative opacities in right hemithorax, specifically in right upper lung zone and also subtle left retrocardiac opacity Currently on vanc and zosyn (started 10/31) MRSA probe negative and blood cultures pending Sputum cultures not collected Procal elevated ID recommended supportive care at this time for COVID-19 infection as long as SORA   HTN Tachycardia-resolved Patient not on BP meds at home Patient denies pain, does not appear agitated Amlodipine 10 mg daily, coreg 6.25mg BID, hydralazine PRN while inpt Will decrease norvasc to 5mg daily, continue coreg 6.25mg BID, until pt has appointment with PCP and can manage as appropriate   GERD Resume home prilosec 40mg   History of MSSA bacteremia Pt was recently treated with IV vanc and discharged on abx outpatient, pt was supposed to have antibiotics last until 11/4 Blood cultures negative MRSA probe negative Pt completes course of vancomycin tomorrow
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Chemotherapy, Chest X-ray abnormal, Condition aggravated, Diabetes insipidus
Clinical narrative: Hypernatremia - resolved Hypokalemia - resolved Diabetes insipidus Fatigue BMP on admission shows Na 153, K 2.7 Na 144, K 4.1 11/3 Pt has documented history of diabetes insipidus- follows with Dr with endocrine, treated with DDAVP - Resume home DDAVP - Replace potassium  - Trend BMP - Pt received D5W, now stopped - Encourage PO fluid intake - Endocrine consulted - suggested DI possibly related to AML but unclear etiology - Recommend outpatient follow up with endocrinology   Pancytopenia due to chemotherapy AML Getting chemo, last treatment 10/10/22 Restart pancytopenia prophylaxis, acyclovir, diflucan, levaquin was held while inpt as pt was tx with zosyn, will restart levaquin upon discharge for 5 day course Venetoclax held in setting of pancytopenia, will defer to heme/onc when to restart   Multifocal pneumonia COVID-19 infection Suspect pneumonia likely viral due to COVID Symptoms started 10/29, tested positive on admission, SORA CXR 10/31/22 shows ill defined consolidative opacities in right hemithorax, specifically in right upper lung zone and also subtle left retrocardiac opacity Currently on vanc and zosyn (started 10/31) MRSA probe negative and blood cultures pending Sputum cultures not collected Procal elevated ID recommended supportive care at this time for COVID-19 infection as long as SORA   HTN Tachycardia-resolved Patient not on BP meds at home Patient denies pain, does not appear agitated Amlodipine 10 mg daily, coreg 6.25mg BID, hydralazine PRN while inpt Will decrease norvasc to 5mg daily, continue coreg 6.25mg BID, until pt has appointment with PCP and can manage as appropriate   GERD Resume home prilosec 40mg   History of MSSA bacteremia Pt was recently treated with IV vanc and discharged on abx outpatient, pt was supposed to have antibiotics last until 11/4 Blood cultures negative MRSA probe negative Pt completes course of vancomycin tomorrow
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Electrolyte substitution therapy, Fatigue, Gastrooesophageal reflux disease, Hypernatraemia, Hypertension
Clinical narrative: Hypernatremia - resolved Hypokalemia - resolved Diabetes insipidus Fatigue BMP on admission shows Na 153, K 2.7 Na 144, K 4.1 11/3 Pt has documented history of diabetes insipidus- follows with Dr with endocrine, treated with DDAVP - Resume home DDAVP - Replace potassium  - Trend BMP - Pt received D5W, now stopped - Encourage PO fluid intake - Endocrine consulted - suggested DI possibly related to AML but unclear etiology - Recommend outpatient follow up with endocrinology   Pancytopenia due to chemotherapy AML Getting chemo, last treatment 10/10/22 Restart pancytopenia prophylaxis, acyclovir, diflucan, levaquin was held while inpt as pt was tx with zosyn, will restart levaquin upon discharge for 5 day course Venetoclax held in setting of pancytopenia, will defer to heme/onc when to restart   Multifocal pneumonia COVID-19 infection Suspect pneumonia likely viral due to COVID Symptoms started 10/29, tested positive on admission, SORA CXR 10/31/22 shows ill defined consolidative opacities in right hemithorax, specifically in right upper lung zone and also subtle left retrocardiac opacity Currently on vanc and zosyn (started 10/31) MRSA probe negative and blood cultures pending Sputum cultures not collected Procal elevated ID recommended supportive care at this time for COVID-19 infection as long as SORA   HTN Tachycardia-resolved Patient not on BP meds at home Patient denies pain, does not appear agitated Amlodipine 10 mg daily, coreg 6.25mg BID, hydralazine PRN while inpt Will decrease norvasc to 5mg daily, continue coreg 6.25mg BID, until pt has appointment with PCP and can manage as appropriate   GERD Resume home prilosec 40mg   History of MSSA bacteremia Pt was recently treated with IV vanc and discharged on abx outpatient, pt was supposed to have antibiotics last until 11/4 Blood cultures negative MRSA probe negative Pt completes course of vancomycin tomorrow
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Hypokalaemia, Lung consolidation, Lung opacity, Malaise, Metabolic function test
Clinical narrative: Hypernatremia - resolved Hypokalemia - resolved Diabetes insipidus Fatigue BMP on admission shows Na 153, K 2.7 Na 144, K 4.1 11/3 Pt has documented history of diabetes insipidus- follows with Dr with endocrine, treated with DDAVP - Resume home DDAVP - Replace potassium  - Trend BMP - Pt received D5W, now stopped - Encourage PO fluid intake - Endocrine consulted - suggested DI possibly related to AML but unclear etiology - Recommend outpatient follow up with endocrinology   Pancytopenia due to chemotherapy AML Getting chemo, last treatment 10/10/22 Restart pancytopenia prophylaxis, acyclovir, diflucan, levaquin was held while inpt as pt was tx with zosyn, will restart levaquin upon discharge for 5 day course Venetoclax held in setting of pancytopenia, will defer to heme/onc when to restart   Multifocal pneumonia COVID-19 infection Suspect pneumonia likely viral due to COVID Symptoms started 10/29, tested positive on admission, SORA CXR 10/31/22 shows ill defined consolidative opacities in right hemithorax, specifically in right upper lung zone and also subtle left retrocardiac opacity Currently on vanc and zosyn (started 10/31) MRSA probe negative and blood cultures pending Sputum cultures not collected Procal elevated ID recommended supportive care at this time for COVID-19 infection as long as SORA   HTN Tachycardia-resolved Patient not on BP meds at home Patient denies pain, does not appear agitated Amlodipine 10 mg daily, coreg 6.25mg BID, hydralazine PRN while inpt Will decrease norvasc to 5mg daily, continue coreg 6.25mg BID, until pt has appointment with PCP and can manage as appropriate   GERD Resume home prilosec 40mg   History of MSSA bacteremia Pt was recently treated with IV vanc and discharged on abx outpatient, pt was supposed to have antibiotics last until 11/4 Blood cultures negative MRSA probe negative Pt completes course of vancomycin tomorrow
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Pancytopenia, Procalcitonin increased, SARS-CoV-2 test positive, Staphylococcus test negative, Tachycardia
Clinical narrative: Hypernatremia - resolved Hypokalemia - resolved Diabetes insipidus Fatigue BMP on admission shows Na 153, K 2.7 Na 144, K 4.1 11/3 Pt has documented history of diabetes insipidus- follows with Dr with endocrine, treated with DDAVP - Resume home DDAVP - Replace potassium  - Trend BMP - Pt received D5W, now stopped - Encourage PO fluid intake - Endocrine consulted - suggested DI possibly related to AML but unclear etiology - Recommend outpatient follow up with endocrinology   Pancytopenia due to chemotherapy AML Getting chemo, last treatment 10/10/22 Restart pancytopenia prophylaxis, acyclovir, diflucan, levaquin was held while inpt as pt was tx with zosyn, will restart levaquin upon discharge for 5 day course Venetoclax held in setting of pancytopenia, will defer to heme/onc when to restart   Multifocal pneumonia COVID-19 infection Suspect pneumonia likely viral due to COVID Symptoms started 10/29, tested positive on admission, SORA CXR 10/31/22 shows ill defined consolidative opacities in right hemithorax, specifically in right upper lung zone and also subtle left retrocardiac opacity Currently on vanc and zosyn (started 10/31) MRSA probe negative and blood cultures pending Sputum cultures not collected Procal elevated ID recommended supportive care at this time for COVID-19 infection as long as SORA   HTN Tachycardia-resolved Patient not on BP meds at home Patient denies pain, does not appear agitated Amlodipine 10 mg daily, coreg 6.25mg BID, hydralazine PRN while inpt Will decrease norvasc to 5mg daily, continue coreg 6.25mg BID, until pt has appointment with PCP and can manage as appropriate   GERD Resume home prilosec 40mg   History of MSSA bacteremia Pt was recently treated with IV vanc and discharged on abx outpatient, pt was supposed to have antibiotics last until 11/4 Blood cultures negative MRSA probe negative Pt completes course of vancomycin tomorrow
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Bladder cancer
Clinical narrative: Pt got diagnosed with bladder cancer
Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal distension, Acute respiratory failure, Bacteraemia, COVID-19, COVID-19 pneumonia
Clinical narrative: Patient is a 75 y.o. female of MD with history of COPD that presented to Hospital with shortness of breath for 1 week.  Patient was positive for COVID-19 and CXR concerning for multifocal pneumonia.  Patient required BiPAP since admission and was DNR DNI.  She gradually continued to decline and became unresponsive to physical stimulation and painful stimulation.  Additionally, patient's abdomen is distended due to air from BiPAP.  Discussed at length with family members we decided patient should be DNRCC and be taken off the BiPAP.  Comfort orders were placed, BiPAP was removed.  Patient expired at 1245 on 11/7/2022.   Acute hypoxic respiratory failure secondary to multifocal pneumonia from Covid-19 Virus Infection Acute COPD exacerbation secondary to pneumonia Concern for Viral Sepsis due to COVID pneumonia, POA Date of onset of symptoms: 1 week Symptoms present on admission: Shortness of breath Date of covid positive test: 11/1/2022 Vaccination status: vaccinated Imaging: Chest x-ray shows multifocal pneumonia Oxygen requirements on admission: BiPAP Current oxygen requirements: BiPAP with supplemental oxygen FiO2 40% Medical therapy: Completed course of remdesivir.  Was being given steroids.  Bacteremia Blood culture turned positive with staph species. This is likely contaminant. Discontinued vancomycin.  Thrombocytopenia Possibly related to viral infection   Nutrition Patient unable to take adequate nutrition being BiPAP dependent
Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Chest X-ray abnormal, Chronic obstructive pulmonary disease, Condition aggravated, Death, Dyspnoea
Clinical narrative: Patient is a 75 y.o. female of MD with history of COPD that presented to Hospital with shortness of breath for 1 week.  Patient was positive for COVID-19 and CXR concerning for multifocal pneumonia.  Patient required BiPAP since admission and was DNR DNI.  She gradually continued to decline and became unresponsive to physical stimulation and painful stimulation.  Additionally, patient's abdomen is distended due to air from BiPAP.  Discussed at length with family members we decided patient should be DNRCC and be taken off the BiPAP.  Comfort orders were placed, BiPAP was removed.  Patient expired at 1245 on 11/7/2022.   Acute hypoxic respiratory failure secondary to multifocal pneumonia from Covid-19 Virus Infection Acute COPD exacerbation secondary to pneumonia Concern for Viral Sepsis due to COVID pneumonia, POA Date of onset of symptoms: 1 week Symptoms present on admission: Shortness of breath Date of covid positive test: 11/1/2022 Vaccination status: vaccinated Imaging: Chest x-ray shows multifocal pneumonia Oxygen requirements on admission: BiPAP Current oxygen requirements: BiPAP with supplemental oxygen FiO2 40% Medical therapy: Completed course of remdesivir.  Was being given steroids.  Bacteremia Blood culture turned positive with staph species. This is likely contaminant. Discontinued vancomycin.  Thrombocytopenia Possibly related to viral infection   Nutrition Patient unable to take adequate nutrition being BiPAP dependent
Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: General physical health deterioration, Malnutrition, Pneumonia, Positive airway pressure therapy, SARS-CoV-2 test positive
Clinical narrative: Patient is a 75 y.o. female of MD with history of COPD that presented to Hospital with shortness of breath for 1 week.  Patient was positive for COVID-19 and CXR concerning for multifocal pneumonia.  Patient required BiPAP since admission and was DNR DNI.  She gradually continued to decline and became unresponsive to physical stimulation and painful stimulation.  Additionally, patient's abdomen is distended due to air from BiPAP.  Discussed at length with family members we decided patient should be DNRCC and be taken off the BiPAP.  Comfort orders were placed, BiPAP was removed.  Patient expired at 1245 on 11/7/2022.   Acute hypoxic respiratory failure secondary to multifocal pneumonia from Covid-19 Virus Infection Acute COPD exacerbation secondary to pneumonia Concern for Viral Sepsis due to COVID pneumonia, POA Date of onset of symptoms: 1 week Symptoms present on admission: Shortness of breath Date of covid positive test: 11/1/2022 Vaccination status: vaccinated Imaging: Chest x-ray shows multifocal pneumonia Oxygen requirements on admission: BiPAP Current oxygen requirements: BiPAP with supplemental oxygen FiO2 40% Medical therapy: Completed course of remdesivir.  Was being given steroids.  Bacteremia Blood culture turned positive with staph species. This is likely contaminant. Discontinued vancomycin.  Thrombocytopenia Possibly related to viral infection   Nutrition Patient unable to take adequate nutrition being BiPAP dependent
Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Staphylococcus test positive, Therapy cessation, Thrombocytopenia, Unresponsive to stimuli
Clinical narrative: Patient is a 75 y.o. female of MD with history of COPD that presented to Hospital with shortness of breath for 1 week.  Patient was positive for COVID-19 and CXR concerning for multifocal pneumonia.  Patient required BiPAP since admission and was DNR DNI.  She gradually continued to decline and became unresponsive to physical stimulation and painful stimulation.  Additionally, patient's abdomen is distended due to air from BiPAP.  Discussed at length with family members we decided patient should be DNRCC and be taken off the BiPAP.  Comfort orders were placed, BiPAP was removed.  Patient expired at 1245 on 11/7/2022.   Acute hypoxic respiratory failure secondary to multifocal pneumonia from Covid-19 Virus Infection Acute COPD exacerbation secondary to pneumonia Concern for Viral Sepsis due to COVID pneumonia, POA Date of onset of symptoms: 1 week Symptoms present on admission: Shortness of breath Date of covid positive test: 11/1/2022 Vaccination status: vaccinated Imaging: Chest x-ray shows multifocal pneumonia Oxygen requirements on admission: BiPAP Current oxygen requirements: BiPAP with supplemental oxygen FiO2 40% Medical therapy: Completed course of remdesivir.  Was being given steroids.  Bacteremia Blood culture turned positive with staph species. This is likely contaminant. Discontinued vancomycin.  Thrombocytopenia Possibly related to viral infection   Nutrition Patient unable to take adequate nutrition being BiPAP dependent
Age: 92.0
Sex: F
Vaccine: COVID19
Symptoms: Acute myocardial infarction, Anaemia macrocytic, Angiogram pulmonary abnormal, Anticoagulant therapy, Aortic stenosis
Clinical narrative: Patient is a 93 y.o. female patient of local MD with history of CAD, HTN and AS who presented to Hospital with a cc of progressive DOE      Acute pulmonary embolism with RHS  COVID 19 infection  P/w acute onset DOE.  Etiology likely multifactorial given findings below   CXR: relatively unremarkable  CTPA with RLL PE w/ RHS, e/o Pulm HTN  Echo outlined below   LE duplex negative for DVT  Started on heparin, transitioned to warfarin with lovenox bridge.    CRP elevated, will monitor while in house.  Decadron and remdesivir per COVID 19 protocol with plans to discharge on decadron for 10 total days of therapy   Stable on RA at time of discharge    Acute macrocytic anemia  Baseline hgb 12-13, dropped to 10.7 today in the setting of anticoagulation  Macrocytosis concerning for acute bleed however no melena, hematochezia or hematemesis   iron studies, B12 level reviewed.  Continue PO iron on discharge  Repeat CBC in 1 week in outpatient setting    New onset systolic heart failure  Severe tricuspid regurgitation  Severe aortic stenosis   Pulmonary HTN   NSTEMI, unable to determine type as refused ischemic w/u  Echo obtained in the setting of PE and e/o RHS on CTPA  Echo: LVEF 39% (down from 60%), severe AS, severe TR and multiple WMA noted. RVSP 80mmhg   EKG w/ LBBB which is chronic   Evaluated by cardiology, patient has declined any ischemic w/u at this time and has opted for medical management   Continue statin, BB and ACEi as well as plavix on discharge  RX for PRN lasix on discharge given EF and valve disease    Cancer screening  No recent mammogram.  Last colonoscopy 2016.    Will defer cancer screening to the outpatient setting though unlikely to change management    Urinary frequency  Noted today, UA pending collection  Will f/u UA and send RX for abx if indicated.