chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 50.0
Sex: M
Vaccine: COVID19
Symptoms: Brain natriuretic peptide increased, COVID-19 pneumonia, Cardiac stress test abnormal, Chest X-ray abnormal, Chest pain
Clinical narrative: Patient is a 53 y.o. male patient of DO with history of HTN, HLD, CAD s/p PCI, OA, fibromyalgia presented to Hospital with chest pain, SOB. Problem based management in the hospital is as follows:   Acute Hypoxic Respiratory Failure, resoled COVID-19 virus pneumonia Acute onset chest pain/shortness of breath early a.m. 9/30.  O2 sats initially 89% on room air with swift recovery with 4 to 6 L nasal cannula. VBG wnl. CXR with interstitial opacities, edema versus infiltrates.  CT PE with no PE, pulmonary edema with bilateral pleural effusions. COVID (+). Suspect AHRF multifactorial due to COVID, slight volume overload.  Continued scheduled breathing treatments, prn albuterol S/p 60mg solumedrol in ED, de-escalated Decadron, discharged on taper Received remdesivir x2 days Continue supplemental O2 to maintain sats >90%, now back on room air Blood and sputum cultures NTD Procal negative ID were following   Chest Pain, resolved CAD s/p PCI Chronic Angina Elevated Troponin  Elevated BNP Known coronary disease and chronic angina with previous left heart cath 7/12/2022 with DES x3 across chronically occluded circumflex artery/obtuse marginal branch.  Distally noted to have moderate right coronary disease, and patent stent previously placed in LAD, 30% proximal left main lesion.  Has since had an echo 3/23 which was normal. Repeat stress test 3/23 due to ongoing chest pain, that despite being abnormal showed no ischemia.  Last follow-up with Dr. 6/7/2023 with recommendation to continue current regimen, continue DAPT for now.  In ED, BNP 117, initial trop 85-- >202. ECG with ST depressions I, II, aVl, normal T  waves.  Imaging with noted pulmonary edema. States current symptoms feel more severe than chronic angina, does not have radiation similar to last time when he had an MI.  Given up-trending trop/non-specific ECG abnormalities, initiated on heparin drip, discontinued heparin drip at discharge Gentle IV lasix 20mg x1 Monitored on Tele Continued plavix, ranolazine, imdur HTN tx as below Cardiology consulted, appreciate recs, do not feel respiratory failure secondary to heart failure, no further inpatient work-up recommended.   Hypokalemia, resolved K 3.3 on admission, s/p 40mEq KCl  HTN BP on arrival 209/133-- >170/84. Suspect elevated trop as above related to acute illness and not indicative of hypertensive emergency from elevated BP.  Continued home meds   HLD Continued statin   T2DM Diabetic Neuropathy Gastroparesis Last A1c 1/20/23 was 8.2. Current home meds include: glipizide 10mgTID, 70/30 30u BID.  Lantus 20 units + SSI while admitted,  Discharged back on home meds   Fibromyalgia Continued prn tramadol   Depression Continued sertraline   RLS Continued requip   BPH Continued flomax   OSA Does not tolerate CPAP. Currently being evaluated for Inspire   After 2 days of hospital stay, patient was doing well so he was discharged in stable condition. Advised to f/u with PCP and cardiology. All questions and concerns were addressed before discharge.
Age: 50.0
Sex: M
Vaccine: COVID19
Symptoms: Glycosylated haemoglobin increased, Hypervolaemia, Hypokalaemia, Lung infiltration, Lung opacity
Clinical narrative: Patient is a 53 y.o. male patient of DO with history of HTN, HLD, CAD s/p PCI, OA, fibromyalgia presented to Hospital with chest pain, SOB. Problem based management in the hospital is as follows:   Acute Hypoxic Respiratory Failure, resoled COVID-19 virus pneumonia Acute onset chest pain/shortness of breath early a.m. 9/30.  O2 sats initially 89% on room air with swift recovery with 4 to 6 L nasal cannula. VBG wnl. CXR with interstitial opacities, edema versus infiltrates.  CT PE with no PE, pulmonary edema with bilateral pleural effusions. COVID (+). Suspect AHRF multifactorial due to COVID, slight volume overload.  Continued scheduled breathing treatments, prn albuterol S/p 60mg solumedrol in ED, de-escalated Decadron, discharged on taper Received remdesivir x2 days Continue supplemental O2 to maintain sats >90%, now back on room air Blood and sputum cultures NTD Procal negative ID were following   Chest Pain, resolved CAD s/p PCI Chronic Angina Elevated Troponin  Elevated BNP Known coronary disease and chronic angina with previous left heart cath 7/12/2022 with DES x3 across chronically occluded circumflex artery/obtuse marginal branch.  Distally noted to have moderate right coronary disease, and patent stent previously placed in LAD, 30% proximal left main lesion.  Has since had an echo 3/23 which was normal. Repeat stress test 3/23 due to ongoing chest pain, that despite being abnormal showed no ischemia.  Last follow-up with Dr. 6/7/2023 with recommendation to continue current regimen, continue DAPT for now.  In ED, BNP 117, initial trop 85-- >202. ECG with ST depressions I, II, aVl, normal T  waves.  Imaging with noted pulmonary edema. States current symptoms feel more severe than chronic angina, does not have radiation similar to last time when he had an MI.  Given up-trending trop/non-specific ECG abnormalities, initiated on heparin drip, discontinued heparin drip at discharge Gentle IV lasix 20mg x1 Monitored on Tele Continued plavix, ranolazine, imdur HTN tx as below Cardiology consulted, appreciate recs, do not feel respiratory failure secondary to heart failure, no further inpatient work-up recommended.   Hypokalemia, resolved K 3.3 on admission, s/p 40mEq KCl  HTN BP on arrival 209/133-- >170/84. Suspect elevated trop as above related to acute illness and not indicative of hypertensive emergency from elevated BP.  Continued home meds   HLD Continued statin   T2DM Diabetic Neuropathy Gastroparesis Last A1c 1/20/23 was 8.2. Current home meds include: glipizide 10mgTID, 70/30 30u BID.  Lantus 20 units + SSI while admitted,  Discharged back on home meds   Fibromyalgia Continued prn tramadol   Depression Continued sertraline   RLS Continued requip   BPH Continued flomax   OSA Does not tolerate CPAP. Currently being evaluated for Inspire   After 2 days of hospital stay, patient was doing well so he was discharged in stable condition. Advised to f/u with PCP and cardiology. All questions and concerns were addressed before discharge.
Age: 50.0
Sex: M
Vaccine: COVID19
Symptoms: Pleural effusion, Procalcitonin normal, Pulmonary oedema, SARS-CoV-2 test positive, Sputum culture
Clinical narrative: Patient is a 53 y.o. male patient of DO with history of HTN, HLD, CAD s/p PCI, OA, fibromyalgia presented to Hospital with chest pain, SOB. Problem based management in the hospital is as follows:   Acute Hypoxic Respiratory Failure, resoled COVID-19 virus pneumonia Acute onset chest pain/shortness of breath early a.m. 9/30.  O2 sats initially 89% on room air with swift recovery with 4 to 6 L nasal cannula. VBG wnl. CXR with interstitial opacities, edema versus infiltrates.  CT PE with no PE, pulmonary edema with bilateral pleural effusions. COVID (+). Suspect AHRF multifactorial due to COVID, slight volume overload.  Continued scheduled breathing treatments, prn albuterol S/p 60mg solumedrol in ED, de-escalated Decadron, discharged on taper Received remdesivir x2 days Continue supplemental O2 to maintain sats >90%, now back on room air Blood and sputum cultures NTD Procal negative ID were following   Chest Pain, resolved CAD s/p PCI Chronic Angina Elevated Troponin  Elevated BNP Known coronary disease and chronic angina with previous left heart cath 7/12/2022 with DES x3 across chronically occluded circumflex artery/obtuse marginal branch.  Distally noted to have moderate right coronary disease, and patent stent previously placed in LAD, 30% proximal left main lesion.  Has since had an echo 3/23 which was normal. Repeat stress test 3/23 due to ongoing chest pain, that despite being abnormal showed no ischemia.  Last follow-up with Dr. 6/7/2023 with recommendation to continue current regimen, continue DAPT for now.  In ED, BNP 117, initial trop 85-- >202. ECG with ST depressions I, II, aVl, normal T  waves.  Imaging with noted pulmonary edema. States current symptoms feel more severe than chronic angina, does not have radiation similar to last time when he had an MI.  Given up-trending trop/non-specific ECG abnormalities, initiated on heparin drip, discontinued heparin drip at discharge Gentle IV lasix 20mg x1 Monitored on Tele Continued plavix, ranolazine, imdur HTN tx as below Cardiology consulted, appreciate recs, do not feel respiratory failure secondary to heart failure, no further inpatient work-up recommended.   Hypokalemia, resolved K 3.3 on admission, s/p 40mEq KCl  HTN BP on arrival 209/133-- >170/84. Suspect elevated trop as above related to acute illness and not indicative of hypertensive emergency from elevated BP.  Continued home meds   HLD Continued statin   T2DM Diabetic Neuropathy Gastroparesis Last A1c 1/20/23 was 8.2. Current home meds include: glipizide 10mgTID, 70/30 30u BID.  Lantus 20 units + SSI while admitted,  Discharged back on home meds   Fibromyalgia Continued prn tramadol   Depression Continued sertraline   RLS Continued requip   BPH Continued flomax   OSA Does not tolerate CPAP. Currently being evaluated for Inspire   After 2 days of hospital stay, patient was doing well so he was discharged in stable condition. Advised to f/u with PCP and cardiology. All questions and concerns were addressed before discharge.
Age: 50.0
Sex: M
Vaccine: COVID19
Symptoms: Troponin increased
Clinical narrative: Patient is a 53 y.o. male patient of DO with history of HTN, HLD, CAD s/p PCI, OA, fibromyalgia presented to Hospital with chest pain, SOB. Problem based management in the hospital is as follows:   Acute Hypoxic Respiratory Failure, resoled COVID-19 virus pneumonia Acute onset chest pain/shortness of breath early a.m. 9/30.  O2 sats initially 89% on room air with swift recovery with 4 to 6 L nasal cannula. VBG wnl. CXR with interstitial opacities, edema versus infiltrates.  CT PE with no PE, pulmonary edema with bilateral pleural effusions. COVID (+). Suspect AHRF multifactorial due to COVID, slight volume overload.  Continued scheduled breathing treatments, prn albuterol S/p 60mg solumedrol in ED, de-escalated Decadron, discharged on taper Received remdesivir x2 days Continue supplemental O2 to maintain sats >90%, now back on room air Blood and sputum cultures NTD Procal negative ID were following   Chest Pain, resolved CAD s/p PCI Chronic Angina Elevated Troponin  Elevated BNP Known coronary disease and chronic angina with previous left heart cath 7/12/2022 with DES x3 across chronically occluded circumflex artery/obtuse marginal branch.  Distally noted to have moderate right coronary disease, and patent stent previously placed in LAD, 30% proximal left main lesion.  Has since had an echo 3/23 which was normal. Repeat stress test 3/23 due to ongoing chest pain, that despite being abnormal showed no ischemia.  Last follow-up with Dr. 6/7/2023 with recommendation to continue current regimen, continue DAPT for now.  In ED, BNP 117, initial trop 85-- >202. ECG with ST depressions I, II, aVl, normal T  waves.  Imaging with noted pulmonary edema. States current symptoms feel more severe than chronic angina, does not have radiation similar to last time when he had an MI.  Given up-trending trop/non-specific ECG abnormalities, initiated on heparin drip, discontinued heparin drip at discharge Gentle IV lasix 20mg x1 Monitored on Tele Continued plavix, ranolazine, imdur HTN tx as below Cardiology consulted, appreciate recs, do not feel respiratory failure secondary to heart failure, no further inpatient work-up recommended.   Hypokalemia, resolved K 3.3 on admission, s/p 40mEq KCl  HTN BP on arrival 209/133-- >170/84. Suspect elevated trop as above related to acute illness and not indicative of hypertensive emergency from elevated BP.  Continued home meds   HLD Continued statin   T2DM Diabetic Neuropathy Gastroparesis Last A1c 1/20/23 was 8.2. Current home meds include: glipizide 10mgTID, 70/30 30u BID.  Lantus 20 units + SSI while admitted,  Discharged back on home meds   Fibromyalgia Continued prn tramadol   Depression Continued sertraline   RLS Continued requip   BPH Continued flomax   OSA Does not tolerate CPAP. Currently being evaluated for Inspire   After 2 days of hospital stay, patient was doing well so he was discharged in stable condition. Advised to f/u with PCP and cardiology. All questions and concerns were addressed before discharge.
Age: 68.0
Sex: M
Vaccine: FLUA4
Symptoms: Dyskinesia, Injection site pain
Clinical narrative: extra soreness at injection site, involuntary arm movements (arm would swing and move on its own - exaggerated movements)
Age: 5.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: No adverse effects known, but patient was administered the vaccination past the "beyond use date" that goes into effect when changed from being stored frozen to refrigerated.
Age: 6.0
Sex: U
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: No adverse effects known, but patient was administered the vaccination past the "beyond use date" that goes into effect when changed from being stored frozen to refrigerated.
Age: 93.0
Sex: F
Vaccine: PNC20
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling
Clinical narrative: red itchy and raised area at injection site began the day after injection
Age: 66.0
Sex: M
Vaccine: PPV
Symptoms: Erythema, Peripheral swelling
Clinical narrative: Swelling and redness on right arm (injection arm)
Age: 8.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: No adverse effects known, but patient was administered the vaccination past the "beyond use date" that goes into effect when changed from being stored frozen to refrigerated.
Age: 61.0
Sex: F
Vaccine: COVID19
Symptoms: Decreased appetite, Fatigue, Malaise, Pain in extremity
Clinical narrative: Patient describes arm soreness, fatigue, lack of apetite and general malaise the morning after vaccination day.
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Urticaria
Clinical narrative: hives
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Atrial fibrillation, COVID-19, Cardiac telemetry abnormal, Delirium, Fall
Clinical narrative: Admit date: 12/16/2023  Discharge date:  12/20/2023  Admitting Physician: MD   Attending Physician at the Time of Discharge: MD  Primary Care Physician: NP  Reason for Admission:  COVID-19 positive and frequent falls  Brief Summary of Hospital Stay: Patient is a 82 years old male with history of dementia, Afib on Coumadin, hypertension, RA and BPH presented to the emergency department for multiple ground level falls while on warfarin.  In the emergency department patient was found to have a positive COVID-19 test and INR of 4.5.  Patient was hemodynamically stable.  On admission, patient was oriented to place only.  Lasix was hold because he was clinically dry.  Medications that could potentially lead to confusion were held.  No obvious source of infection.  Delirium protocol was initiated. Pharmacy consulted to dose his warfarin.  Folate supplement was given for folic acid deficiency.  Telemetry showed controlled AFib.  Family agreed with continue warfarin. The next day, patient was more oriented but continued to have intermittent delirium.  He worked with PT and OT who recommended rehab at discharge.  Today he is medically ready to be discharged. Discharged to Rehab Facility.
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Folate deficiency, International normalised ratio increased, SARS-CoV-2 test positive
Clinical narrative: Admit date: 12/16/2023  Discharge date:  12/20/2023  Admitting Physician: MD   Attending Physician at the Time of Discharge: MD  Primary Care Physician: NP  Reason for Admission:  COVID-19 positive and frequent falls  Brief Summary of Hospital Stay: Patient is a 82 years old male with history of dementia, Afib on Coumadin, hypertension, RA and BPH presented to the emergency department for multiple ground level falls while on warfarin.  In the emergency department patient was found to have a positive COVID-19 test and INR of 4.5.  Patient was hemodynamically stable.  On admission, patient was oriented to place only.  Lasix was hold because he was clinically dry.  Medications that could potentially lead to confusion were held.  No obvious source of infection.  Delirium protocol was initiated. Pharmacy consulted to dose his warfarin.  Folate supplement was given for folic acid deficiency.  Telemetry showed controlled AFib.  Family agreed with continue warfarin. The next day, patient was more oriented but continued to have intermittent delirium.  He worked with PT and OT who recommended rehab at discharge.  Today he is medically ready to be discharged. Discharged to Rehab Facility.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal pain, Back pain, Decreased appetite, Diarrhoea, Dizziness postural
Clinical narrative: Admit date: 12/18/2023  Discharge date: 12/21/23  Admitting Physician:  DO   Attending Physician at the Time of Discharge: MD  Primary Care Physician: DO  Reason for Admission: Evaluation for hypotension  Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures) Pt is a 65 YO female with PMHx of ESRD on peritoneal dialysis, hx of T2DM, HLD, HTN that presented to the ED with c/o hypotension. Patient reports she has not been feeling good for the past 3 weeks. She has had intermittent diarrhea, nausea and vomiting. Patient reports checking blood pressure today and systolic was in the 70's. Patient called her nephrologist and was told to come to ED to be evaluated. Patient reports she has been managing diarrhea with imodium which usually controls it for about a day or two and it comes back. Patient denies recent abx use. Son at bedside reports patient discussed this with pcp and is supposed to follow up with GI. Patient reports she has been keeping up with her dialysis however skipped today's due to not feeling well. Patient reports syncopal episode last week. She woke up on the floor. She denies hitting head. Patient reports she continues to be dizzy with position changes.  Patient reports intermittent associated sharp shooting pain on her left side that radiates to her back.  Denies any aggravating or relieving factors.  Patient reports associated abdominal soreness mostly on the left lower abdomen.  Patient reports decreased appetite for the past week.  She reports a 5 lb weight loss.  Patient denies fever or chills.  She denies sick contacts.  Patient denies abdominal pain. Patient denies chest pain, shortness of breath,  headache.  Patient reports she still makes urine and denies any associated urinary symptoms.  Patient is on iron and reports dark stools.    Discharged to home.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Feeling abnormal, Flank pain, Hypotension, Malaise, Nausea
Clinical narrative: Admit date: 12/18/2023  Discharge date: 12/21/23  Admitting Physician:  DO   Attending Physician at the Time of Discharge: MD  Primary Care Physician: DO  Reason for Admission: Evaluation for hypotension  Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures) Pt is a 65 YO female with PMHx of ESRD on peritoneal dialysis, hx of T2DM, HLD, HTN that presented to the ED with c/o hypotension. Patient reports she has not been feeling good for the past 3 weeks. She has had intermittent diarrhea, nausea and vomiting. Patient reports checking blood pressure today and systolic was in the 70's. Patient called her nephrologist and was told to come to ED to be evaluated. Patient reports she has been managing diarrhea with imodium which usually controls it for about a day or two and it comes back. Patient denies recent abx use. Son at bedside reports patient discussed this with pcp and is supposed to follow up with GI. Patient reports she has been keeping up with her dialysis however skipped today's due to not feeling well. Patient reports syncopal episode last week. She woke up on the floor. She denies hitting head. Patient reports she continues to be dizzy with position changes.  Patient reports intermittent associated sharp shooting pain on her left side that radiates to her back.  Denies any aggravating or relieving factors.  Patient reports associated abdominal soreness mostly on the left lower abdomen.  Patient reports decreased appetite for the past week.  She reports a 5 lb weight loss.  Patient denies fever or chills.  She denies sick contacts.  Patient denies abdominal pain. Patient denies chest pain, shortness of breath,  headache.  Patient reports she still makes urine and denies any associated urinary symptoms.  Patient is on iron and reports dark stools.    Discharged to home.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Pain, Syncope, Vomiting, Weight decreased
Clinical narrative: Admit date: 12/18/2023  Discharge date: 12/21/23  Admitting Physician:  DO   Attending Physician at the Time of Discharge: MD  Primary Care Physician: DO  Reason for Admission: Evaluation for hypotension  Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures) Pt is a 65 YO female with PMHx of ESRD on peritoneal dialysis, hx of T2DM, HLD, HTN that presented to the ED with c/o hypotension. Patient reports she has not been feeling good for the past 3 weeks. She has had intermittent diarrhea, nausea and vomiting. Patient reports checking blood pressure today and systolic was in the 70's. Patient called her nephrologist and was told to come to ED to be evaluated. Patient reports she has been managing diarrhea with imodium which usually controls it for about a day or two and it comes back. Patient denies recent abx use. Son at bedside reports patient discussed this with pcp and is supposed to follow up with GI. Patient reports she has been keeping up with her dialysis however skipped today's due to not feeling well. Patient reports syncopal episode last week. She woke up on the floor. She denies hitting head. Patient reports she continues to be dizzy with position changes.  Patient reports intermittent associated sharp shooting pain on her left side that radiates to her back.  Denies any aggravating or relieving factors.  Patient reports associated abdominal soreness mostly on the left lower abdomen.  Patient reports decreased appetite for the past week.  She reports a 5 lb weight loss.  Patient denies fever or chills.  She denies sick contacts.  Patient denies abdominal pain. Patient denies chest pain, shortness of breath,  headache.  Patient reports she still makes urine and denies any associated urinary symptoms.  Patient is on iron and reports dark stools.    Discharged to home.
Age: 70.0
Sex: F
Vaccine: RSV
Symptoms: Arthralgia, Myalgia
Clinical narrative: Still have acute muscle/joint pain especially in middle back and neck 4 days after receiving vaccine
Age: 74.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, C-reactive protein increased, COVID-19 pneumonia, Computerised tomogram thorax, Cough
Clinical narrative: Patient is a 75 y.o. female patient of MD with history of HTN, Glaucoma, Chordoma tumor of nose s/p remote hx of resection and nasal reconstruction,GERD and  migraine headache  who presents to Hospital ER with 4 day of cough, sore throat and shortness of breath. He is being admitted with COVID19 pneumonia.   Discharge Diagnoses:   Acute hypoxic respiratory failure Left sided pneumonia Covid-19 Virus Infection Date of onset of symptoms: 10/25/23 Symptoms present on admission: sorethroat, cough, shortness of breath Date of covid positive test: 9/29/2023 Vaccination status: vaccinated Imaging: CT chest Oxygen requirements on admission: 2L  Current oxygen requirements: Room air Medical therapy: remdesivir, steroids, and rocephin Consultants following: none Anticipated special isolation end date: 10/5/23 Continue supportive care, IS, antitussives CRP 158.9, ferritin 279 Discharged on short course of Decadron and doxycycline     HTN Continued losartan     Migraine Continued home med regimen   GERD On pepcid, continued   Glaucoma Stable Continued home eye drops (Xalatan)
Age: 74.0
Sex: F
Vaccine: COVID19-2
Symptoms: Dyspnoea, Oropharyngeal pain, SARS-CoV-2 test positive, Serum ferritin increased
Clinical narrative: Patient is a 75 y.o. female patient of MD with history of HTN, Glaucoma, Chordoma tumor of nose s/p remote hx of resection and nasal reconstruction,GERD and  migraine headache  who presents to Hospital ER with 4 day of cough, sore throat and shortness of breath. He is being admitted with COVID19 pneumonia.   Discharge Diagnoses:   Acute hypoxic respiratory failure Left sided pneumonia Covid-19 Virus Infection Date of onset of symptoms: 10/25/23 Symptoms present on admission: sorethroat, cough, shortness of breath Date of covid positive test: 9/29/2023 Vaccination status: vaccinated Imaging: CT chest Oxygen requirements on admission: 2L  Current oxygen requirements: Room air Medical therapy: remdesivir, steroids, and rocephin Consultants following: none Anticipated special isolation end date: 10/5/23 Continue supportive care, IS, antitussives CRP 158.9, ferritin 279 Discharged on short course of Decadron and doxycycline     HTN Continued losartan     Migraine Continued home med regimen   GERD On pepcid, continued   Glaucoma Stable Continued home eye drops (Xalatan)
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, COVID-19, Cough, Encephalopathy, Memory impairment
Clinical narrative: DOB:   Admit date: 12/20/2023  Discharge date: 12/21/23  Admitting Physician: DO   Attending Physician at the Time of Discharge: DO  Primary Care Physician: PA Summary HPI:"Past medical history includes diabetes mellitus type 2 with use of insulin, COPD with nocturnal hypoxemia and use of oxygen at night, myocardial infarction, paroxysmal atrial fibrillation, obesity, stroke, hypertension, dyslipidemia, peripheral arterial disease, left below knee amputation with wound, seizures, GERD, osteoarthritis and degenerative disc disease, insomnia, depression, anxiety, and tobacco and substance abuse.  Patient is alone and is unable to provide history. Talking about a variety of topics, for example, "girl hit me, told I need catheter in my head, bleeding again, remember passing out, guy swung at me.""  Please see admission H&P for further details.  Summary of Hospitalization:Patient was admitted for encephalopathy which was thought to be secondary to COVID infection and AKI with sedating meds.  Was given fluids and his AKI resolved.  His acute encephalopathy also resolved and he was alert and oriented x3 and wanted to go home.  Wound care wanted to have general surgery evaluate patient for possible debridement but he refused.  After discussion, will send on 7 day course of Levaquin and follow up with wound center as outpatient.  Patient instructed to hold Seroquel while taking Levaquin.  Home health care set up for patient.  Regarding his COVID infection, patient has been coughing for few days but does not appear to be symptomatic.  Patient did not want to talk with me, so unable to discuss COVID therapies. Discharged to home.
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Refusal of treatment by patient
Clinical narrative: DOB:   Admit date: 12/20/2023  Discharge date: 12/21/23  Admitting Physician: DO   Attending Physician at the Time of Discharge: DO  Primary Care Physician: PA Summary HPI:"Past medical history includes diabetes mellitus type 2 with use of insulin, COPD with nocturnal hypoxemia and use of oxygen at night, myocardial infarction, paroxysmal atrial fibrillation, obesity, stroke, hypertension, dyslipidemia, peripheral arterial disease, left below knee amputation with wound, seizures, GERD, osteoarthritis and degenerative disc disease, insomnia, depression, anxiety, and tobacco and substance abuse.  Patient is alone and is unable to provide history. Talking about a variety of topics, for example, "girl hit me, told I need catheter in my head, bleeding again, remember passing out, guy swung at me.""  Please see admission H&P for further details.  Summary of Hospitalization:Patient was admitted for encephalopathy which was thought to be secondary to COVID infection and AKI with sedating meds.  Was given fluids and his AKI resolved.  His acute encephalopathy also resolved and he was alert and oriented x3 and wanted to go home.  Wound care wanted to have general surgery evaluate patient for possible debridement but he refused.  After discussion, will send on 7 day course of Levaquin and follow up with wound center as outpatient.  Patient instructed to hold Seroquel while taking Levaquin.  Home health care set up for patient.  Regarding his COVID infection, patient has been coughing for few days but does not appear to be symptomatic.  Patient did not want to talk with me, so unable to discuss COVID therapies. Discharged to home.
Age: 92.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Asthenia, Blood creatinine increased, Blood culture positive
Clinical narrative: Patient is a 93 y.o. male patient of MD with history of dyslipidemia, left lower extremity ischemia with recent admission from 8/12/2023 to 8/15/2023 when had left femoral thromboembolectomy and was discharged on Eliquis presented to Hospital with complaints of weakness, shortness of breath.  Patient tested positive for COVID-19 infection on 10/6/2023.  While in the ER patient found to be hypoxic and was placed on oxygen and is admitted for further management.    Acute hypoxic respiratory failure-improved Covid-19 Virus Infection Sepsis due to above Date of onset of symptoms: 10/9 Symptoms present on admission: Shortness of breath and weakness Date of covid positive test: 10/6 Vaccination status: vaccinated Imaging: Chest x-ray Oxygen requirements on admission: 4L nasal cannula Current oxygen requirements: 3L O2 Medical therapy: remdesivir and steroids Consultants following: ID/pulmonary Anticipated special isolation end date: 10/19 Chest x-ray and CT chest reviewed showing some patchy airspace opacification Sputum culture normal flora.  Urine antigens negative Worsening CXR and respiratory status on 10/11 Decadron, remdesivir - completed Continue oral Lasix 20 mg twice daily Incentive spirometer, PEP, duonebs, Mucinex added on 10/12 HFNC was  titrated to nasal canula Qualified for home O2 Home O2 on discharge   Abnormal blood culture Gram-positive cocci in cluster Likely Contamination   Mild AKI - resolved Baseline creatinine 0.9 creatinine of 1.36 on admission S/P IVF   PAD Recent acute occlusion of left SFA, popliteal artery and tibioperoneal trunk S/P thromboembolectomy Family concerned about cost of Eliquis  Switch to coumadin on 10/16 - stopped eliquis due to cost Bridged with lovenox  Plan to DC with warfarin 5mg  INR check Monday w/PCP at facility   Left renal mass Patient was recently seen by urologist, patient hematuria has resolved UA with no blood Outpatient follow-up with urology as recommended as urology felt during last admission that patient lesion was small and did not warrant any urgent intervention
Age: 92.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Dyspnoea, Gram stain positive
Clinical narrative: Patient is a 93 y.o. male patient of MD with history of dyslipidemia, left lower extremity ischemia with recent admission from 8/12/2023 to 8/15/2023 when had left femoral thromboembolectomy and was discharged on Eliquis presented to Hospital with complaints of weakness, shortness of breath.  Patient tested positive for COVID-19 infection on 10/6/2023.  While in the ER patient found to be hypoxic and was placed on oxygen and is admitted for further management.    Acute hypoxic respiratory failure-improved Covid-19 Virus Infection Sepsis due to above Date of onset of symptoms: 10/9 Symptoms present on admission: Shortness of breath and weakness Date of covid positive test: 10/6 Vaccination status: vaccinated Imaging: Chest x-ray Oxygen requirements on admission: 4L nasal cannula Current oxygen requirements: 3L O2 Medical therapy: remdesivir and steroids Consultants following: ID/pulmonary Anticipated special isolation end date: 10/19 Chest x-ray and CT chest reviewed showing some patchy airspace opacification Sputum culture normal flora.  Urine antigens negative Worsening CXR and respiratory status on 10/11 Decadron, remdesivir - completed Continue oral Lasix 20 mg twice daily Incentive spirometer, PEP, duonebs, Mucinex added on 10/12 HFNC was  titrated to nasal canula Qualified for home O2 Home O2 on discharge   Abnormal blood culture Gram-positive cocci in cluster Likely Contamination   Mild AKI - resolved Baseline creatinine 0.9 creatinine of 1.36 on admission S/P IVF   PAD Recent acute occlusion of left SFA, popliteal artery and tibioperoneal trunk S/P thromboembolectomy Family concerned about cost of Eliquis  Switch to coumadin on 10/16 - stopped eliquis due to cost Bridged with lovenox  Plan to DC with warfarin 5mg  INR check Monday w/PCP at facility   Left renal mass Patient was recently seen by urologist, patient hematuria has resolved UA with no blood Outpatient follow-up with urology as recommended as urology felt during last admission that patient lesion was small and did not warrant any urgent intervention
Age: 92.0
Sex: M
Vaccine: COVID19
Symptoms: Haematuria, Hypoxia, Lung opacity, Peripheral arterial occlusive disease, Peripheral artery occlusion
Clinical narrative: Patient is a 93 y.o. male patient of MD with history of dyslipidemia, left lower extremity ischemia with recent admission from 8/12/2023 to 8/15/2023 when had left femoral thromboembolectomy and was discharged on Eliquis presented to Hospital with complaints of weakness, shortness of breath.  Patient tested positive for COVID-19 infection on 10/6/2023.  While in the ER patient found to be hypoxic and was placed on oxygen and is admitted for further management.    Acute hypoxic respiratory failure-improved Covid-19 Virus Infection Sepsis due to above Date of onset of symptoms: 10/9 Symptoms present on admission: Shortness of breath and weakness Date of covid positive test: 10/6 Vaccination status: vaccinated Imaging: Chest x-ray Oxygen requirements on admission: 4L nasal cannula Current oxygen requirements: 3L O2 Medical therapy: remdesivir and steroids Consultants following: ID/pulmonary Anticipated special isolation end date: 10/19 Chest x-ray and CT chest reviewed showing some patchy airspace opacification Sputum culture normal flora.  Urine antigens negative Worsening CXR and respiratory status on 10/11 Decadron, remdesivir - completed Continue oral Lasix 20 mg twice daily Incentive spirometer, PEP, duonebs, Mucinex added on 10/12 HFNC was  titrated to nasal canula Qualified for home O2 Home O2 on discharge   Abnormal blood culture Gram-positive cocci in cluster Likely Contamination   Mild AKI - resolved Baseline creatinine 0.9 creatinine of 1.36 on admission S/P IVF   PAD Recent acute occlusion of left SFA, popliteal artery and tibioperoneal trunk S/P thromboembolectomy Family concerned about cost of Eliquis  Switch to coumadin on 10/16 - stopped eliquis due to cost Bridged with lovenox  Plan to DC with warfarin 5mg  INR check Monday w/PCP at facility   Left renal mass Patient was recently seen by urologist, patient hematuria has resolved UA with no blood Outpatient follow-up with urology as recommended as urology felt during last admission that patient lesion was small and did not warrant any urgent intervention
Age: 92.0
Sex: M
Vaccine: COVID19
Symptoms: Renal mass, Respiratory distress, SARS-CoV-2 test positive, Sepsis, Sputum culture
Clinical narrative: Patient is a 93 y.o. male patient of MD with history of dyslipidemia, left lower extremity ischemia with recent admission from 8/12/2023 to 8/15/2023 when had left femoral thromboembolectomy and was discharged on Eliquis presented to Hospital with complaints of weakness, shortness of breath.  Patient tested positive for COVID-19 infection on 10/6/2023.  While in the ER patient found to be hypoxic and was placed on oxygen and is admitted for further management.    Acute hypoxic respiratory failure-improved Covid-19 Virus Infection Sepsis due to above Date of onset of symptoms: 10/9 Symptoms present on admission: Shortness of breath and weakness Date of covid positive test: 10/6 Vaccination status: vaccinated Imaging: Chest x-ray Oxygen requirements on admission: 4L nasal cannula Current oxygen requirements: 3L O2 Medical therapy: remdesivir and steroids Consultants following: ID/pulmonary Anticipated special isolation end date: 10/19 Chest x-ray and CT chest reviewed showing some patchy airspace opacification Sputum culture normal flora.  Urine antigens negative Worsening CXR and respiratory status on 10/11 Decadron, remdesivir - completed Continue oral Lasix 20 mg twice daily Incentive spirometer, PEP, duonebs, Mucinex added on 10/12 HFNC was  titrated to nasal canula Qualified for home O2 Home O2 on discharge   Abnormal blood culture Gram-positive cocci in cluster Likely Contamination   Mild AKI - resolved Baseline creatinine 0.9 creatinine of 1.36 on admission S/P IVF   PAD Recent acute occlusion of left SFA, popliteal artery and tibioperoneal trunk S/P thromboembolectomy Family concerned about cost of Eliquis  Switch to coumadin on 10/16 - stopped eliquis due to cost Bridged with lovenox  Plan to DC with warfarin 5mg  INR check Monday w/PCP at facility   Left renal mass Patient was recently seen by urologist, patient hematuria has resolved UA with no blood Outpatient follow-up with urology as recommended as urology felt during last admission that patient lesion was small and did not warrant any urgent intervention
Age: 92.0
Sex: M
Vaccine: COVID19
Symptoms: Thromboembolectomy, Urine analysis normal, Urine antigen test
Clinical narrative: Patient is a 93 y.o. male patient of MD with history of dyslipidemia, left lower extremity ischemia with recent admission from 8/12/2023 to 8/15/2023 when had left femoral thromboembolectomy and was discharged on Eliquis presented to Hospital with complaints of weakness, shortness of breath.  Patient tested positive for COVID-19 infection on 10/6/2023.  While in the ER patient found to be hypoxic and was placed on oxygen and is admitted for further management.    Acute hypoxic respiratory failure-improved Covid-19 Virus Infection Sepsis due to above Date of onset of symptoms: 10/9 Symptoms present on admission: Shortness of breath and weakness Date of covid positive test: 10/6 Vaccination status: vaccinated Imaging: Chest x-ray Oxygen requirements on admission: 4L nasal cannula Current oxygen requirements: 3L O2 Medical therapy: remdesivir and steroids Consultants following: ID/pulmonary Anticipated special isolation end date: 10/19 Chest x-ray and CT chest reviewed showing some patchy airspace opacification Sputum culture normal flora.  Urine antigens negative Worsening CXR and respiratory status on 10/11 Decadron, remdesivir - completed Continue oral Lasix 20 mg twice daily Incentive spirometer, PEP, duonebs, Mucinex added on 10/12 HFNC was  titrated to nasal canula Qualified for home O2 Home O2 on discharge   Abnormal blood culture Gram-positive cocci in cluster Likely Contamination   Mild AKI - resolved Baseline creatinine 0.9 creatinine of 1.36 on admission S/P IVF   PAD Recent acute occlusion of left SFA, popliteal artery and tibioperoneal trunk S/P thromboembolectomy Family concerned about cost of Eliquis  Switch to coumadin on 10/16 - stopped eliquis due to cost Bridged with lovenox  Plan to DC with warfarin 5mg  INR check Monday w/PCP at facility   Left renal mass Patient was recently seen by urologist, patient hematuria has resolved UA with no blood Outpatient follow-up with urology as recommended as urology felt during last admission that patient lesion was small and did not warrant any urgent intervention
Age: 13.0
Sex: F
Vaccine: HEP, HPV9, MMR, MNQ, TDAP, VARCEL
Symptoms: Expired product administered, No adverse event
Clinical narrative: No adverse event occurred. On today 12/22/23 I saw that our sterile diluent (lot# X004654) expired on 12/12/23. Patient was vaccinated with MMR and Varicella on 12/13/23 with the same expired diluent. No complications occurred, no adverse events occurred. Reached out to RN at Immunization Branch and she reported that patient will need to be revaccinated. Vaers report completed since administration error occurred.
Age: 76.0
Sex: M
Vaccine: COVID19-2
Symptoms: Eye pain, Glossodynia, Iridocyclitis, Pain in jaw, Photophobia
Clinical narrative: Right eye pain, photophobia, cloudy vision, scleral injection - acute onset - seen in ER and referred to opthomology.  Seen 4 days later     where slit lamp exam showed 1-2+ WBC in anterior chamber c/w anterior unveitis.  Since sx had partially resolved, no treatment started.  The next day there was aching pain in right submandibular area and in right side of tongue which lasted 2 days then resolved.  Mild uveitis symptoms persist.
Age: 76.0
Sex: M
Vaccine: COVID19-2
Symptoms: Slit-lamp tests abnormal, Vision blurred
Clinical narrative: Right eye pain, photophobia, cloudy vision, scleral injection - acute onset - seen in ER and referred to opthomology.  Seen 4 days later     where slit lamp exam showed 1-2+ WBC in anterior chamber c/w anterior unveitis.  Since sx had partially resolved, no treatment started.  The next day there was aching pain in right submandibular area and in right side of tongue which lasted 2 days then resolved.  Mild uveitis symptoms persist.
Age: 87.0
Sex: M
Vaccine: COVID19-2
Symptoms: Asthenia, Blood creatinine increased, Brain natriuretic peptide increased, COVID-19, Chest X-ray abnormal
Clinical narrative: Patient is a 88 y.o. male with history of a fib on Eliquis, SSS with pacemaker HTN, T2DM admitted to the hospital on 10/24/2023 for recent falls at home & chronic weakness. Patient had overall negative trauma workup, however was found to have hazy opacifications on CXR with elevated BNP. Echo was done which showed stable HF not in exacerbation. Additionally was found to be COVID-19 positive with positive orthostatics. During his hospital course he remained normotensive while holding all of his home antihypertensives. Falls were likely related to hypotension secondary to COVID19 infection and antihypertensive medications. During the hospital stay he was seen by PT/OT who recommended SNF which patient declined and was made aware of risks associated. He was offered remdesivir for his COVID infection and patient declined.    Action Items to be Addressed After Discharge 1) COVID19 Infection - follow up symptoms, supportive 2) HTN/HF - Consider restarting home BP medications; BMP 3) Orthostatic Hypotension; follow up PT 4) Atrial Fibrillation - Adjusted eliquis 5mg BID to eliquis 2.5mg BID given age/renal function   Discharge Diagnosis and Associated Hospital Course   Generalized weakness Recurrent falls COVID-19 infection Orthostatic hypotension HTN Patient had  unwitnessed falls at home, one directly after standing. CXR (10/24) with mild hazy opacification L lung. Found to have orthostatic hypotension, likely culprit for falls. Seen by PT/OT recommending SNF, family declined, discussed risks and patient and family understood. Family declined COVID19 treatment with remdesivir. Considered outpatient PT while patient is only in area for roughly approximately 2 weeks before returning to home. Referral placed.  -Consider restarting and/or decreasing home antihypertensives, repeat BMP -Follow up PT   Chronic HFpEF BNP elevated 2,560. Increased from 734 in 2019. Likely related to infection vs less likely heart failure exacerbation. -Echo (10/26) with EF 59, LVH normal wall function. RSVP 46   CKD AKI, unable to rule in nor ruled out  Consistent with baseline. Unclear etiology as diabetes is well controlled.  - On admission Cr 1.82, 1.4 on discharge   Chronic Afib On home Eliquis 5 mg BID - held on admission due to bleeding from wounds on upper extremity - Restarted Eliquis dose reduced to 2.5mg BID given CKD and age   Anemia of Chronic Disease - Stable Appears consistent with baseline.   Chronic Thrombocytopenia - Stable Consistent with baseline   NIDT2DM  Diet-controlled - Continue SSI while admitted.
Age: 87.0
Sex: M
Vaccine: COVID19-2
Symptoms: Echocardiogram normal, Ejection fraction normal, Fall, Limb injury, Lung opacity
Clinical narrative: Patient is a 88 y.o. male with history of a fib on Eliquis, SSS with pacemaker HTN, T2DM admitted to the hospital on 10/24/2023 for recent falls at home & chronic weakness. Patient had overall negative trauma workup, however was found to have hazy opacifications on CXR with elevated BNP. Echo was done which showed stable HF not in exacerbation. Additionally was found to be COVID-19 positive with positive orthostatics. During his hospital course he remained normotensive while holding all of his home antihypertensives. Falls were likely related to hypotension secondary to COVID19 infection and antihypertensive medications. During the hospital stay he was seen by PT/OT who recommended SNF which patient declined and was made aware of risks associated. He was offered remdesivir for his COVID infection and patient declined.    Action Items to be Addressed After Discharge 1) COVID19 Infection - follow up symptoms, supportive 2) HTN/HF - Consider restarting home BP medications; BMP 3) Orthostatic Hypotension; follow up PT 4) Atrial Fibrillation - Adjusted eliquis 5mg BID to eliquis 2.5mg BID given age/renal function   Discharge Diagnosis and Associated Hospital Course   Generalized weakness Recurrent falls COVID-19 infection Orthostatic hypotension HTN Patient had  unwitnessed falls at home, one directly after standing. CXR (10/24) with mild hazy opacification L lung. Found to have orthostatic hypotension, likely culprit for falls. Seen by PT/OT recommending SNF, family declined, discussed risks and patient and family understood. Family declined COVID19 treatment with remdesivir. Considered outpatient PT while patient is only in area for roughly approximately 2 weeks before returning to home. Referral placed.  -Consider restarting and/or decreasing home antihypertensives, repeat BMP -Follow up PT   Chronic HFpEF BNP elevated 2,560. Increased from 734 in 2019. Likely related to infection vs less likely heart failure exacerbation. -Echo (10/26) with EF 59, LVH normal wall function. RSVP 46   CKD AKI, unable to rule in nor ruled out  Consistent with baseline. Unclear etiology as diabetes is well controlled.  - On admission Cr 1.82, 1.4 on discharge   Chronic Afib On home Eliquis 5 mg BID - held on admission due to bleeding from wounds on upper extremity - Restarted Eliquis dose reduced to 2.5mg BID given CKD and age   Anemia of Chronic Disease - Stable Appears consistent with baseline.   Chronic Thrombocytopenia - Stable Consistent with baseline   NIDT2DM  Diet-controlled - Continue SSI while admitted.