chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 80.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Acute respiratory failure, Agitation, Body temperature increased, COVID-19, Candida infection
Clinical narrative: 10/24/21:  present to ED with complaints short of breath/dyspnea upon rest, fatigue, and cough.  Admitted for acute hypoxic respiratory failure with positive COVID test.  On 3L NC sat 92%, RR20s afebrile, mild cough noted.  Started on IV decadron, IV remdesivir, IV Levaquin (due to extensive allergies), vitamins, dulera. 10/27/21:  continues to be mild SOB, afebrile on 3L NC.  decadron changed to IV Solu-medrol 10/30/21:  Increased oxygen need to 5L NC maintain sat >88% and initiate BiPap at night.  Afebrile, RR 26-30, HR 100-110s.  Aggitated at night. 11/5/21:  improved respirations and cough, on 3-4L NC sat >88%.  changed to oral prednisone, oral fluconazole added for thrush and new onset dysphagia. 11/7/21:  increased cough, chills, Tmax 100.7, requiring 9L NC sat 90% with desat to 70% with activity.  Resumed IV steroids. 11/10/21:  Chest CT shows new bilat. pulmonary infiltrates 11/12/21:  significant SOB at rest requiring 15L HFNC with intermittent BiPap during day and continuous at night. 11/14/21:  RR40s with desat at rest to 80% while on 15L HFNC.  CXR shows new Left sided pneumothorax.  Chest tube placed and BiPap held 11/15/21: Rapid response called for patient significant dyspnea sat 80% on 15L HFNC and NRBM RR36 HR 120.  Portable CXR shows new large right sided pneumothorax with near complete lung collapse.  Patient intubated @0132 and transfered to ICU.  Family meeting held and patient made comfort care.  Terminal extubation @1640 to 10L HFNC.  Patient expired @1700.
Age: 80.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Chest X-ray abnormal, Chest tube insertion, Chills, Computerised tomogram thorax abnormal, Cough
Clinical narrative: 10/24/21:  present to ED with complaints short of breath/dyspnea upon rest, fatigue, and cough.  Admitted for acute hypoxic respiratory failure with positive COVID test.  On 3L NC sat 92%, RR20s afebrile, mild cough noted.  Started on IV decadron, IV remdesivir, IV Levaquin (due to extensive allergies), vitamins, dulera. 10/27/21:  continues to be mild SOB, afebrile on 3L NC.  decadron changed to IV Solu-medrol 10/30/21:  Increased oxygen need to 5L NC maintain sat >88% and initiate BiPap at night.  Afebrile, RR 26-30, HR 100-110s.  Aggitated at night. 11/5/21:  improved respirations and cough, on 3-4L NC sat >88%.  changed to oral prednisone, oral fluconazole added for thrush and new onset dysphagia. 11/7/21:  increased cough, chills, Tmax 100.7, requiring 9L NC sat 90% with desat to 70% with activity.  Resumed IV steroids. 11/10/21:  Chest CT shows new bilat. pulmonary infiltrates 11/12/21:  significant SOB at rest requiring 15L HFNC with intermittent BiPap during day and continuous at night. 11/14/21:  RR40s with desat at rest to 80% while on 15L HFNC.  CXR shows new Left sided pneumothorax.  Chest tube placed and BiPap held 11/15/21: Rapid response called for patient significant dyspnea sat 80% on 15L HFNC and NRBM RR36 HR 120.  Portable CXR shows new large right sided pneumothorax with near complete lung collapse.  Patient intubated @0132 and transfered to ICU.  Family meeting held and patient made comfort care.  Terminal extubation @1640 to 10L HFNC.  Patient expired @1700.
Age: 80.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Death, Dysphagia, Dyspnoea, Dyspnoea at rest, Endotracheal intubation
Clinical narrative: 10/24/21:  present to ED with complaints short of breath/dyspnea upon rest, fatigue, and cough.  Admitted for acute hypoxic respiratory failure with positive COVID test.  On 3L NC sat 92%, RR20s afebrile, mild cough noted.  Started on IV decadron, IV remdesivir, IV Levaquin (due to extensive allergies), vitamins, dulera. 10/27/21:  continues to be mild SOB, afebrile on 3L NC.  decadron changed to IV Solu-medrol 10/30/21:  Increased oxygen need to 5L NC maintain sat >88% and initiate BiPap at night.  Afebrile, RR 26-30, HR 100-110s.  Aggitated at night. 11/5/21:  improved respirations and cough, on 3-4L NC sat >88%.  changed to oral prednisone, oral fluconazole added for thrush and new onset dysphagia. 11/7/21:  increased cough, chills, Tmax 100.7, requiring 9L NC sat 90% with desat to 70% with activity.  Resumed IV steroids. 11/10/21:  Chest CT shows new bilat. pulmonary infiltrates 11/12/21:  significant SOB at rest requiring 15L HFNC with intermittent BiPap during day and continuous at night. 11/14/21:  RR40s with desat at rest to 80% while on 15L HFNC.  CXR shows new Left sided pneumothorax.  Chest tube placed and BiPap held 11/15/21: Rapid response called for patient significant dyspnea sat 80% on 15L HFNC and NRBM RR36 HR 120.  Portable CXR shows new large right sided pneumothorax with near complete lung collapse.  Patient intubated @0132 and transfered to ICU.  Family meeting held and patient made comfort care.  Terminal extubation @1640 to 10L HFNC.  Patient expired @1700.
Age: 80.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Fatigue, Intensive care, Lung infiltration, Oxygen saturation decreased, Pneumothorax
Clinical narrative: 10/24/21:  present to ED with complaints short of breath/dyspnea upon rest, fatigue, and cough.  Admitted for acute hypoxic respiratory failure with positive COVID test.  On 3L NC sat 92%, RR20s afebrile, mild cough noted.  Started on IV decadron, IV remdesivir, IV Levaquin (due to extensive allergies), vitamins, dulera. 10/27/21:  continues to be mild SOB, afebrile on 3L NC.  decadron changed to IV Solu-medrol 10/30/21:  Increased oxygen need to 5L NC maintain sat >88% and initiate BiPap at night.  Afebrile, RR 26-30, HR 100-110s.  Aggitated at night. 11/5/21:  improved respirations and cough, on 3-4L NC sat >88%.  changed to oral prednisone, oral fluconazole added for thrush and new onset dysphagia. 11/7/21:  increased cough, chills, Tmax 100.7, requiring 9L NC sat 90% with desat to 70% with activity.  Resumed IV steroids. 11/10/21:  Chest CT shows new bilat. pulmonary infiltrates 11/12/21:  significant SOB at rest requiring 15L HFNC with intermittent BiPap during day and continuous at night. 11/14/21:  RR40s with desat at rest to 80% while on 15L HFNC.  CXR shows new Left sided pneumothorax.  Chest tube placed and BiPap held 11/15/21: Rapid response called for patient significant dyspnea sat 80% on 15L HFNC and NRBM RR36 HR 120.  Portable CXR shows new large right sided pneumothorax with near complete lung collapse.  Patient intubated @0132 and transfered to ICU.  Family meeting held and patient made comfort care.  Terminal extubation @1640 to 10L HFNC.  Patient expired @1700.
Age: 80.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Positive airway pressure therapy, SARS-CoV-2 test positive
Clinical narrative: 10/24/21:  present to ED with complaints short of breath/dyspnea upon rest, fatigue, and cough.  Admitted for acute hypoxic respiratory failure with positive COVID test.  On 3L NC sat 92%, RR20s afebrile, mild cough noted.  Started on IV decadron, IV remdesivir, IV Levaquin (due to extensive allergies), vitamins, dulera. 10/27/21:  continues to be mild SOB, afebrile on 3L NC.  decadron changed to IV Solu-medrol 10/30/21:  Increased oxygen need to 5L NC maintain sat >88% and initiate BiPap at night.  Afebrile, RR 26-30, HR 100-110s.  Aggitated at night. 11/5/21:  improved respirations and cough, on 3-4L NC sat >88%.  changed to oral prednisone, oral fluconazole added for thrush and new onset dysphagia. 11/7/21:  increased cough, chills, Tmax 100.7, requiring 9L NC sat 90% with desat to 70% with activity.  Resumed IV steroids. 11/10/21:  Chest CT shows new bilat. pulmonary infiltrates 11/12/21:  significant SOB at rest requiring 15L HFNC with intermittent BiPap during day and continuous at night. 11/14/21:  RR40s with desat at rest to 80% while on 15L HFNC.  CXR shows new Left sided pneumothorax.  Chest tube placed and BiPap held 11/15/21: Rapid response called for patient significant dyspnea sat 80% on 15L HFNC and NRBM RR36 HR 120.  Portable CXR shows new large right sided pneumothorax with near complete lung collapse.  Patient intubated @0132 and transfered to ICU.  Family meeting held and patient made comfort care.  Terminal extubation @1640 to 10L HFNC.  Patient expired @1700.
Age: 4.0
Sex: M
Vaccine: FLU4
Symptoms: Dyspnoea, Injection site erythema, Injection site rash, Throat clearing
Clinical narrative: Two hours after flu shot, said was hard to breathe and was holding his chest.  Throat clearing.  Hives all over body (I reviewed pictures and agree these were hives).  Benadryl given.  Called EMS.  To ER.  Symptoms improving when arrived, but not gone.  Given Dexamethasone and monitored for 2 hours.  Epi not given.   The following day, he had a large erythematous macule partially surrounding the area where the shot had ben given, with small raised pale bumps scattered throughout that macular area.
Age: 11.0
Sex: U
Vaccine: COVID19
Symptoms: No adverse event, Wrong technique in product usage process
Clinical narrative: Patient received a dose of Pfizer COVID-19 vaccine pediatric formulation (5-11 years) that may have been reconstituted with a single-use vial of 0.9% NS entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single-use only (to take out 1.3mL then discard). Each time the vial was used, it was swabbed with alcohol and a new syringe was used to enter the vial to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9% NS vial disposed of at the end of each day. The patient did not experience any adverse reaction. At recommendation and due to lack of stability data, it was advised to revaccinate the patient.
Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory distress syndrome, Acute respiratory failure, Anticoagulant therapy, Asthenia
Clinical narrative: 10/28/21: admit weakness, lack of appetite, mild non-productive cough X1week duration with new syncopal episode.  COVID+ test on admission.  RA sat 88% placed on 2LNC, RR 24-26, HR 90, afebrile.  Admit with acute hypoxemic respiratory failure with multilobular COVID PNA and mild AKI CRT 2.4.  Started on IV remdesivir, IV decadron, IV ceftriaxone, IV doxycycline, combivent, heparin SQ. 10/29/21: patient desatting, tachypnic, accessory muscle use.  Placed on 15L HFNC and NRBM.  ABG 7.30/40/50/19.9/BE -6 sat 87%. 10/30/21:  renal function improved CRT 1.6. Started on baricitinib. d-dimer 877 ferritin 1090 10/31/21: AM:  d-dimer 902 ferritin 3500 dopplar negative for DVT.  started on Lovenox 10/31/21:  PM:  HFNC40% and
Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Atrial fibrillation, Blood creatinine increased, Blood gases, Blood pressure decreased, COVID-19
Clinical narrative: 10/28/21: admit weakness, lack of appetite, mild non-productive cough X1week duration with new syncopal episode.  COVID+ test on admission.  RA sat 88% placed on 2LNC, RR 24-26, HR 90, afebrile.  Admit with acute hypoxemic respiratory failure with multilobular COVID PNA and mild AKI CRT 2.4.  Started on IV remdesivir, IV decadron, IV ceftriaxone, IV doxycycline, combivent, heparin SQ. 10/29/21: patient desatting, tachypnic, accessory muscle use.  Placed on 15L HFNC and NRBM.  ABG 7.30/40/50/19.9/BE -6 sat 87%. 10/30/21:  renal function improved CRT 1.6. Started on baricitinib. d-dimer 877 ferritin 1090 10/31/21: AM:  d-dimer 902 ferritin 3500 dopplar negative for DVT.  started on Lovenox 10/31/21:  PM:  HFNC40% and
Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Cardiac failure congestive, Cough, Culture, Death
Clinical narrative: 10/28/21: admit weakness, lack of appetite, mild non-productive cough X1week duration with new syncopal episode.  COVID+ test on admission.  RA sat 88% placed on 2LNC, RR 24-26, HR 90, afebrile.  Admit with acute hypoxemic respiratory failure with multilobular COVID PNA and mild AKI CRT 2.4.  Started on IV remdesivir, IV decadron, IV ceftriaxone, IV doxycycline, combivent, heparin SQ. 10/29/21: patient desatting, tachypnic, accessory muscle use.  Placed on 15L HFNC and NRBM.  ABG 7.30/40/50/19.9/BE -6 sat 87%. 10/30/21:  renal function improved CRT 1.6. Started on baricitinib. d-dimer 877 ferritin 1090 10/31/21: AM:  d-dimer 902 ferritin 3500 dopplar negative for DVT.  started on Lovenox 10/31/21:  PM:  HFNC40% and
Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Decreased appetite, Dyspnoea, Dyspnoea at rest, Endotracheal intubation, Fibrin D dimer
Clinical narrative: 10/28/21: admit weakness, lack of appetite, mild non-productive cough X1week duration with new syncopal episode.  COVID+ test on admission.  RA sat 88% placed on 2LNC, RR 24-26, HR 90, afebrile.  Admit with acute hypoxemic respiratory failure with multilobular COVID PNA and mild AKI CRT 2.4.  Started on IV remdesivir, IV decadron, IV ceftriaxone, IV doxycycline, combivent, heparin SQ. 10/29/21: patient desatting, tachypnic, accessory muscle use.  Placed on 15L HFNC and NRBM.  ABG 7.30/40/50/19.9/BE -6 sat 87%. 10/30/21:  renal function improved CRT 1.6. Started on baricitinib. d-dimer 877 ferritin 1090 10/31/21: AM:  d-dimer 902 ferritin 3500 dopplar negative for DVT.  started on Lovenox 10/31/21:  PM:  HFNC40% and
Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Gastrointestinal haemorrhage, Intensive care, Mechanical ventilation, Myocardial ischaemia, Oxygen saturation decreased
Clinical narrative: 10/28/21: admit weakness, lack of appetite, mild non-productive cough X1week duration with new syncopal episode.  COVID+ test on admission.  RA sat 88% placed on 2LNC, RR 24-26, HR 90, afebrile.  Admit with acute hypoxemic respiratory failure with multilobular COVID PNA and mild AKI CRT 2.4.  Started on IV remdesivir, IV decadron, IV ceftriaxone, IV doxycycline, combivent, heparin SQ. 10/29/21: patient desatting, tachypnic, accessory muscle use.  Placed on 15L HFNC and NRBM.  ABG 7.30/40/50/19.9/BE -6 sat 87%. 10/30/21:  renal function improved CRT 1.6. Started on baricitinib. d-dimer 877 ferritin 1090 10/31/21: AM:  d-dimer 902 ferritin 3500 dopplar negative for DVT.  started on Lovenox 10/31/21:  PM:  HFNC40% and
Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Platelet count decreased, Positive airway pressure therapy, Pyrexia, Renal impairment, Respiratory distress
Clinical narrative: 10/28/21: admit weakness, lack of appetite, mild non-productive cough X1week duration with new syncopal episode.  COVID+ test on admission.  RA sat 88% placed on 2LNC, RR 24-26, HR 90, afebrile.  Admit with acute hypoxemic respiratory failure with multilobular COVID PNA and mild AKI CRT 2.4.  Started on IV remdesivir, IV decadron, IV ceftriaxone, IV doxycycline, combivent, heparin SQ. 10/29/21: patient desatting, tachypnic, accessory muscle use.  Placed on 15L HFNC and NRBM.  ABG 7.30/40/50/19.9/BE -6 sat 87%. 10/30/21:  renal function improved CRT 1.6. Started on baricitinib. d-dimer 877 ferritin 1090 10/31/21: AM:  d-dimer 902 ferritin 3500 dopplar negative for DVT.  started on Lovenox 10/31/21:  PM:  HFNC40% and
Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Sedation, Serum ferritin increased, Syncope, Tachypnoea
Clinical narrative: 10/28/21: admit weakness, lack of appetite, mild non-productive cough X1week duration with new syncopal episode.  COVID+ test on admission.  RA sat 88% placed on 2LNC, RR 24-26, HR 90, afebrile.  Admit with acute hypoxemic respiratory failure with multilobular COVID PNA and mild AKI CRT 2.4.  Started on IV remdesivir, IV decadron, IV ceftriaxone, IV doxycycline, combivent, heparin SQ. 10/29/21: patient desatting, tachypnic, accessory muscle use.  Placed on 15L HFNC and NRBM.  ABG 7.30/40/50/19.9/BE -6 sat 87%. 10/30/21:  renal function improved CRT 1.6. Started on baricitinib. d-dimer 877 ferritin 1090 10/31/21: AM:  d-dimer 902 ferritin 3500 dopplar negative for DVT.  started on Lovenox 10/31/21:  PM:  HFNC40% and
Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Thrombocytopenia, Troponin increased, Ultrasound Doppler normal, Use of accessory respiratory muscles
Clinical narrative: 10/28/21: admit weakness, lack of appetite, mild non-productive cough X1week duration with new syncopal episode.  COVID+ test on admission.  RA sat 88% placed on 2LNC, RR 24-26, HR 90, afebrile.  Admit with acute hypoxemic respiratory failure with multilobular COVID PNA and mild AKI CRT 2.4.  Started on IV remdesivir, IV decadron, IV ceftriaxone, IV doxycycline, combivent, heparin SQ. 10/29/21: patient desatting, tachypnic, accessory muscle use.  Placed on 15L HFNC and NRBM.  ABG 7.30/40/50/19.9/BE -6 sat 87%. 10/30/21:  renal function improved CRT 1.6. Started on baricitinib. d-dimer 877 ferritin 1090 10/31/21: AM:  d-dimer 902 ferritin 3500 dopplar negative for DVT.  started on Lovenox 10/31/21:  PM:  HFNC40% and
Age: 10.0
Sex: U
Vaccine: COVID19
Symptoms: No adverse event, Product preparation issue
Clinical narrative: Patient received a dose of Pfizer COVID-19 vaccine pediatric formulation (5-11 years) that may have been reconstituted with a single-use vial of 0.9% NS entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial was for single-use only (to take out 1.3mL then discard). Each time the vial was used, it was swabbed with alcohol and a new syringe was used to enter the vial to add the diluent to the Pfizer vaccine for reconstitution. The 10mL, 0.9% NS vial disposed of at the end of each day. The patient did not experience any adverse reaction. At recommendation and due to lack of stability data, it was advised to revaccinate the patient.
Age: 62.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Fully vaccinated, not booster. COVID breakthrough infection with inpatient hospital stay.
Age: 67.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Abdominal mass, Abdominal pain, Abdominal wall haematoma, Anticoagulant therapy, Asthenia
Clinical narrative: 11/5/21:  present to ER c/o body aches, general weakness, SOB, cough for 5-7 days.  COVID positive test.  Afebrile, CRP 5.1, d-dimer 280, lipase 678, NA 131, WBC 4.7, HH 18/55, troponin negative.  CT of chest shows ground glass parenchymal opacitize L>R with bullous emphasema, negative for PE.  Given IV decadron and mAb Regeneron.  Sat 90% on RA RR 26 HR 90s.  Patient refused admission and demanded discharge.  DC home with Hospital Care at Home program. 11/6/21:  AM HCaH program follow up with patient.  Sat 88% on RA with desat to 85% with activity.  Refusing to go to ER or PCP.  Home oxygen delivered to patient. 11/6/21:  PM HCaH follow up.  On 4L NC sat 88% with SOB at rest.  Patient agreeable to going to ER 11/6/21 @ 2300 in ER:  Patient arrived SOB, fatigue, afebrile, RR 28-30 sat 90-94% on 5L NC. Glucose 493, WBC 6.9, CRP 5.7, NA 134, EGFR 54.  Admitted to telemetry unit.  Started on baricitinib, dexamethasone, Lovenox, vitamin cocktail, IV Ceftriaxone, IV doxycycline. 11/8/21:  Increase need for 6L NC sat >88&.  crackles throughout and moist non-productive cough.  Afebrile.  SOB with any activity. 11/9/21:  SOB and desat to 80% with movement.  ABG on 10L NC 7.43/30.8/53/20.5 BE -2 sat 86%.  Placed on 15L HFNC. 11/11/21:  BiPaP added at night 10/5 FiO2 100%. 11/13/21:  C/O abdmonimal pain with palpable mass.  CT of abdomen shows new rectus sheath hematoma.  All anticoagulation discontinued.  On 20L HFNC with NRBM to maintain sat >88% 11/15/21:  Down to 15L HFNC with intermittent use of NRBM.  Desat to 65% with ambulation to bathroom.  D-dimer 1078 CRP 2.6 11/17/21:  ABG 7.45/36.7/49/25.6/BE 1.7 sat 86% on 13L HFNC 11/18/21:  Weaned down to 6L NC at rest, 10 L NC with activity sat 90% at rest and 85% with activity.  CXR shows new small left effusion 11/20/21:  Patient leaving AMA despite conversation with pulmonologist and hospitalist.  DC on 6L NC, two week steroid taper, and COVID HCaH program. 11/21/21:  HCaH program follow up to patient home.  Weaned self down to 4L NC sat 85%.  Denies any need for further follow up by program 11/30/21:  Follow up with PCP.  Denies issues.  Still requiring 3L via NC to keep sat > 90% with activity but tolerates RA at rest at times.
Age: 67.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Blood gases, Blood glucose increased, Blood sodium decreased, C-reactive protein increased, COVID-19
Clinical narrative: 11/5/21:  present to ER c/o body aches, general weakness, SOB, cough for 5-7 days.  COVID positive test.  Afebrile, CRP 5.1, d-dimer 280, lipase 678, NA 131, WBC 4.7, HH 18/55, troponin negative.  CT of chest shows ground glass parenchymal opacitize L>R with bullous emphasema, negative for PE.  Given IV decadron and mAb Regeneron.  Sat 90% on RA RR 26 HR 90s.  Patient refused admission and demanded discharge.  DC home with Hospital Care at Home program. 11/6/21:  AM HCaH program follow up with patient.  Sat 88% on RA with desat to 85% with activity.  Refusing to go to ER or PCP.  Home oxygen delivered to patient. 11/6/21:  PM HCaH follow up.  On 4L NC sat 88% with SOB at rest.  Patient agreeable to going to ER 11/6/21 @ 2300 in ER:  Patient arrived SOB, fatigue, afebrile, RR 28-30 sat 90-94% on 5L NC. Glucose 493, WBC 6.9, CRP 5.7, NA 134, EGFR 54.  Admitted to telemetry unit.  Started on baricitinib, dexamethasone, Lovenox, vitamin cocktail, IV Ceftriaxone, IV doxycycline. 11/8/21:  Increase need for 6L NC sat >88&.  crackles throughout and moist non-productive cough.  Afebrile.  SOB with any activity. 11/9/21:  SOB and desat to 80% with movement.  ABG on 10L NC 7.43/30.8/53/20.5 BE -2 sat 86%.  Placed on 15L HFNC. 11/11/21:  BiPaP added at night 10/5 FiO2 100%. 11/13/21:  C/O abdmonimal pain with palpable mass.  CT of abdomen shows new rectus sheath hematoma.  All anticoagulation discontinued.  On 20L HFNC with NRBM to maintain sat >88% 11/15/21:  Down to 15L HFNC with intermittent use of NRBM.  Desat to 65% with ambulation to bathroom.  D-dimer 1078 CRP 2.6 11/17/21:  ABG 7.45/36.7/49/25.6/BE 1.7 sat 86% on 13L HFNC 11/18/21:  Weaned down to 6L NC at rest, 10 L NC with activity sat 90% at rest and 85% with activity.  CXR shows new small left effusion 11/20/21:  Patient leaving AMA despite conversation with pulmonologist and hospitalist.  DC on 6L NC, two week steroid taper, and COVID HCaH program. 11/21/21:  HCaH program follow up to patient home.  Weaned self down to 4L NC sat 85%.  Denies any need for further follow up by program 11/30/21:  Follow up with PCP.  Denies issues.  Still requiring 3L via NC to keep sat > 90% with activity but tolerates RA at rest at times.
Age: 67.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Chest X-ray abnormal, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Cough, Crepitations
Clinical narrative: 11/5/21:  present to ER c/o body aches, general weakness, SOB, cough for 5-7 days.  COVID positive test.  Afebrile, CRP 5.1, d-dimer 280, lipase 678, NA 131, WBC 4.7, HH 18/55, troponin negative.  CT of chest shows ground glass parenchymal opacitize L>R with bullous emphasema, negative for PE.  Given IV decadron and mAb Regeneron.  Sat 90% on RA RR 26 HR 90s.  Patient refused admission and demanded discharge.  DC home with Hospital Care at Home program. 11/6/21:  AM HCaH program follow up with patient.  Sat 88% on RA with desat to 85% with activity.  Refusing to go to ER or PCP.  Home oxygen delivered to patient. 11/6/21:  PM HCaH follow up.  On 4L NC sat 88% with SOB at rest.  Patient agreeable to going to ER 11/6/21 @ 2300 in ER:  Patient arrived SOB, fatigue, afebrile, RR 28-30 sat 90-94% on 5L NC. Glucose 493, WBC 6.9, CRP 5.7, NA 134, EGFR 54.  Admitted to telemetry unit.  Started on baricitinib, dexamethasone, Lovenox, vitamin cocktail, IV Ceftriaxone, IV doxycycline. 11/8/21:  Increase need for 6L NC sat >88&.  crackles throughout and moist non-productive cough.  Afebrile.  SOB with any activity. 11/9/21:  SOB and desat to 80% with movement.  ABG on 10L NC 7.43/30.8/53/20.5 BE -2 sat 86%.  Placed on 15L HFNC. 11/11/21:  BiPaP added at night 10/5 FiO2 100%. 11/13/21:  C/O abdmonimal pain with palpable mass.  CT of abdomen shows new rectus sheath hematoma.  All anticoagulation discontinued.  On 20L HFNC with NRBM to maintain sat >88% 11/15/21:  Down to 15L HFNC with intermittent use of NRBM.  Desat to 65% with ambulation to bathroom.  D-dimer 1078 CRP 2.6 11/17/21:  ABG 7.45/36.7/49/25.6/BE 1.7 sat 86% on 13L HFNC 11/18/21:  Weaned down to 6L NC at rest, 10 L NC with activity sat 90% at rest and 85% with activity.  CXR shows new small left effusion 11/20/21:  Patient leaving AMA despite conversation with pulmonologist and hospitalist.  DC on 6L NC, two week steroid taper, and COVID HCaH program. 11/21/21:  HCaH program follow up to patient home.  Weaned self down to 4L NC sat 85%.  Denies any need for further follow up by program 11/30/21:  Follow up with PCP.  Denies issues.  Still requiring 3L via NC to keep sat > 90% with activity but tolerates RA at rest at times.
Age: 67.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Dyspnoea, Dyspnoea at rest, Dyspnoea exertional, Emphysema, Fatigue
Clinical narrative: 11/5/21:  present to ER c/o body aches, general weakness, SOB, cough for 5-7 days.  COVID positive test.  Afebrile, CRP 5.1, d-dimer 280, lipase 678, NA 131, WBC 4.7, HH 18/55, troponin negative.  CT of chest shows ground glass parenchymal opacitize L>R with bullous emphasema, negative for PE.  Given IV decadron and mAb Regeneron.  Sat 90% on RA RR 26 HR 90s.  Patient refused admission and demanded discharge.  DC home with Hospital Care at Home program. 11/6/21:  AM HCaH program follow up with patient.  Sat 88% on RA with desat to 85% with activity.  Refusing to go to ER or PCP.  Home oxygen delivered to patient. 11/6/21:  PM HCaH follow up.  On 4L NC sat 88% with SOB at rest.  Patient agreeable to going to ER 11/6/21 @ 2300 in ER:  Patient arrived SOB, fatigue, afebrile, RR 28-30 sat 90-94% on 5L NC. Glucose 493, WBC 6.9, CRP 5.7, NA 134, EGFR 54.  Admitted to telemetry unit.  Started on baricitinib, dexamethasone, Lovenox, vitamin cocktail, IV Ceftriaxone, IV doxycycline. 11/8/21:  Increase need for 6L NC sat >88&.  crackles throughout and moist non-productive cough.  Afebrile.  SOB with any activity. 11/9/21:  SOB and desat to 80% with movement.  ABG on 10L NC 7.43/30.8/53/20.5 BE -2 sat 86%.  Placed on 15L HFNC. 11/11/21:  BiPaP added at night 10/5 FiO2 100%. 11/13/21:  C/O abdmonimal pain with palpable mass.  CT of abdomen shows new rectus sheath hematoma.  All anticoagulation discontinued.  On 20L HFNC with NRBM to maintain sat >88% 11/15/21:  Down to 15L HFNC with intermittent use of NRBM.  Desat to 65% with ambulation to bathroom.  D-dimer 1078 CRP 2.6 11/17/21:  ABG 7.45/36.7/49/25.6/BE 1.7 sat 86% on 13L HFNC 11/18/21:  Weaned down to 6L NC at rest, 10 L NC with activity sat 90% at rest and 85% with activity.  CXR shows new small left effusion 11/20/21:  Patient leaving AMA despite conversation with pulmonologist and hospitalist.  DC on 6L NC, two week steroid taper, and COVID HCaH program. 11/21/21:  HCaH program follow up to patient home.  Weaned self down to 4L NC sat 85%.  Denies any need for further follow up by program 11/30/21:  Follow up with PCP.  Denies issues.  Still requiring 3L via NC to keep sat > 90% with activity but tolerates RA at rest at times.
Age: 67.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Fibrin D dimer increased, Fraction of inspired oxygen, Glomerular filtration rate decreased, Haematocrit increased, Haemoglobin normal
Clinical narrative: 11/5/21:  present to ER c/o body aches, general weakness, SOB, cough for 5-7 days.  COVID positive test.  Afebrile, CRP 5.1, d-dimer 280, lipase 678, NA 131, WBC 4.7, HH 18/55, troponin negative.  CT of chest shows ground glass parenchymal opacitize L>R with bullous emphasema, negative for PE.  Given IV decadron and mAb Regeneron.  Sat 90% on RA RR 26 HR 90s.  Patient refused admission and demanded discharge.  DC home with Hospital Care at Home program. 11/6/21:  AM HCaH program follow up with patient.  Sat 88% on RA with desat to 85% with activity.  Refusing to go to ER or PCP.  Home oxygen delivered to patient. 11/6/21:  PM HCaH follow up.  On 4L NC sat 88% with SOB at rest.  Patient agreeable to going to ER 11/6/21 @ 2300 in ER:  Patient arrived SOB, fatigue, afebrile, RR 28-30 sat 90-94% on 5L NC. Glucose 493, WBC 6.9, CRP 5.7, NA 134, EGFR 54.  Admitted to telemetry unit.  Started on baricitinib, dexamethasone, Lovenox, vitamin cocktail, IV Ceftriaxone, IV doxycycline. 11/8/21:  Increase need for 6L NC sat >88&.  crackles throughout and moist non-productive cough.  Afebrile.  SOB with any activity. 11/9/21:  SOB and desat to 80% with movement.  ABG on 10L NC 7.43/30.8/53/20.5 BE -2 sat 86%.  Placed on 15L HFNC. 11/11/21:  BiPaP added at night 10/5 FiO2 100%. 11/13/21:  C/O abdmonimal pain with palpable mass.  CT of abdomen shows new rectus sheath hematoma.  All anticoagulation discontinued.  On 20L HFNC with NRBM to maintain sat >88% 11/15/21:  Down to 15L HFNC with intermittent use of NRBM.  Desat to 65% with ambulation to bathroom.  D-dimer 1078 CRP 2.6 11/17/21:  ABG 7.45/36.7/49/25.6/BE 1.7 sat 86% on 13L HFNC 11/18/21:  Weaned down to 6L NC at rest, 10 L NC with activity sat 90% at rest and 85% with activity.  CXR shows new small left effusion 11/20/21:  Patient leaving AMA despite conversation with pulmonologist and hospitalist.  DC on 6L NC, two week steroid taper, and COVID HCaH program. 11/21/21:  HCaH program follow up to patient home.  Weaned self down to 4L NC sat 85%.  Denies any need for further follow up by program 11/30/21:  Follow up with PCP.  Denies issues.  Still requiring 3L via NC to keep sat > 90% with activity but tolerates RA at rest at times.
Age: 67.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Lipase increased, Lung opacity, Oxygen saturation decreased, Pain, Pleural effusion
Clinical narrative: 11/5/21:  present to ER c/o body aches, general weakness, SOB, cough for 5-7 days.  COVID positive test.  Afebrile, CRP 5.1, d-dimer 280, lipase 678, NA 131, WBC 4.7, HH 18/55, troponin negative.  CT of chest shows ground glass parenchymal opacitize L>R with bullous emphasema, negative for PE.  Given IV decadron and mAb Regeneron.  Sat 90% on RA RR 26 HR 90s.  Patient refused admission and demanded discharge.  DC home with Hospital Care at Home program. 11/6/21:  AM HCaH program follow up with patient.  Sat 88% on RA with desat to 85% with activity.  Refusing to go to ER or PCP.  Home oxygen delivered to patient. 11/6/21:  PM HCaH follow up.  On 4L NC sat 88% with SOB at rest.  Patient agreeable to going to ER 11/6/21 @ 2300 in ER:  Patient arrived SOB, fatigue, afebrile, RR 28-30 sat 90-94% on 5L NC. Glucose 493, WBC 6.9, CRP 5.7, NA 134, EGFR 54.  Admitted to telemetry unit.  Started on baricitinib, dexamethasone, Lovenox, vitamin cocktail, IV Ceftriaxone, IV doxycycline. 11/8/21:  Increase need for 6L NC sat >88&.  crackles throughout and moist non-productive cough.  Afebrile.  SOB with any activity. 11/9/21:  SOB and desat to 80% with movement.  ABG on 10L NC 7.43/30.8/53/20.5 BE -2 sat 86%.  Placed on 15L HFNC. 11/11/21:  BiPaP added at night 10/5 FiO2 100%. 11/13/21:  C/O abdmonimal pain with palpable mass.  CT of abdomen shows new rectus sheath hematoma.  All anticoagulation discontinued.  On 20L HFNC with NRBM to maintain sat >88% 11/15/21:  Down to 15L HFNC with intermittent use of NRBM.  Desat to 65% with ambulation to bathroom.  D-dimer 1078 CRP 2.6 11/17/21:  ABG 7.45/36.7/49/25.6/BE 1.7 sat 86% on 13L HFNC 11/18/21:  Weaned down to 6L NC at rest, 10 L NC with activity sat 90% at rest and 85% with activity.  CXR shows new small left effusion 11/20/21:  Patient leaving AMA despite conversation with pulmonologist and hospitalist.  DC on 6L NC, two week steroid taper, and COVID HCaH program. 11/21/21:  HCaH program follow up to patient home.  Weaned self down to 4L NC sat 85%.  Denies any need for further follow up by program 11/30/21:  Follow up with PCP.  Denies issues.  Still requiring 3L via NC to keep sat > 90% with activity but tolerates RA at rest at times.
Age: 67.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Positive airway pressure therapy, SARS-CoV-2 test positive, Troponin, White blood cell count decreased
Clinical narrative: 11/5/21:  present to ER c/o body aches, general weakness, SOB, cough for 5-7 days.  COVID positive test.  Afebrile, CRP 5.1, d-dimer 280, lipase 678, NA 131, WBC 4.7, HH 18/55, troponin negative.  CT of chest shows ground glass parenchymal opacitize L>R with bullous emphasema, negative for PE.  Given IV decadron and mAb Regeneron.  Sat 90% on RA RR 26 HR 90s.  Patient refused admission and demanded discharge.  DC home with Hospital Care at Home program. 11/6/21:  AM HCaH program follow up with patient.  Sat 88% on RA with desat to 85% with activity.  Refusing to go to ER or PCP.  Home oxygen delivered to patient. 11/6/21:  PM HCaH follow up.  On 4L NC sat 88% with SOB at rest.  Patient agreeable to going to ER 11/6/21 @ 2300 in ER:  Patient arrived SOB, fatigue, afebrile, RR 28-30 sat 90-94% on 5L NC. Glucose 493, WBC 6.9, CRP 5.7, NA 134, EGFR 54.  Admitted to telemetry unit.  Started on baricitinib, dexamethasone, Lovenox, vitamin cocktail, IV Ceftriaxone, IV doxycycline. 11/8/21:  Increase need for 6L NC sat >88&.  crackles throughout and moist non-productive cough.  Afebrile.  SOB with any activity. 11/9/21:  SOB and desat to 80% with movement.  ABG on 10L NC 7.43/30.8/53/20.5 BE -2 sat 86%.  Placed on 15L HFNC. 11/11/21:  BiPaP added at night 10/5 FiO2 100%. 11/13/21:  C/O abdmonimal pain with palpable mass.  CT of abdomen shows new rectus sheath hematoma.  All anticoagulation discontinued.  On 20L HFNC with NRBM to maintain sat >88% 11/15/21:  Down to 15L HFNC with intermittent use of NRBM.  Desat to 65% with ambulation to bathroom.  D-dimer 1078 CRP 2.6 11/17/21:  ABG 7.45/36.7/49/25.6/BE 1.7 sat 86% on 13L HFNC 11/18/21:  Weaned down to 6L NC at rest, 10 L NC with activity sat 90% at rest and 85% with activity.  CXR shows new small left effusion 11/20/21:  Patient leaving AMA despite conversation with pulmonologist and hospitalist.  DC on 6L NC, two week steroid taper, and COVID HCaH program. 11/21/21:  HCaH program follow up to patient home.  Weaned self down to 4L NC sat 85%.  Denies any need for further follow up by program 11/30/21:  Follow up with PCP.  Denies issues.  Still requiring 3L via NC to keep sat > 90% with activity but tolerates RA at rest at times.
Age: 50.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: A syringe containing vaccine that was reconstituted up to 9hrs previously was used. The single use syringe was stored in the refrigerator once reconstituted.
Age: 44.0
Sex: U
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: Administration error, given past beyond use date, no adverse event associated
Age: 37.0
Sex: F
Vaccine: COVID19
Symptoms: Blood potassium decreased, Electrocardiogram normal, Malaise, Palpitations
Clinical narrative: Start to have palpitations on 12/6 in the morning. Became really bad on 12/8 and went to the local urgent care center. ECG test looked bad so that they referred me to ER at local hospital. Injected fluid and took Potassium and went back home after 3 hours.  Still not feeling well and taking Metoprolol right now
Age: 35.0
Sex: F
Vaccine: COVID19
Symptoms: Hypoaesthesia oral, Tongue pruritus
Clinical narrative: Pt. reported to vaccinator (EMS), and nurse, present in Pfizer vaccination area at a Health Center, that she was beginning to experience numbness to her lips and itchiness to her tongue at approximately 0935 after receiving her second dose of Pfizer per proper protocol. The information was reported to this nurse. This nurse obtained Pt?s VS at 0937: 98.0-140/101-88-20 and 0939: 98.0-140/98-88-20. Pt.?s symptoms did not subside. Pt. remained alert and oriented x4. Pt. gave consent for this nurse to administer Epinephrine. Epinephrine administered at 0942 per proper protocol. EMS contacted. Administrative Manager contacted and informed. Pt.?s symptoms subsided. EMS arrived at 0950. Pt. agreed to transport to ER for evaluation/ treatment. Pt. transported via gurney at 0955.
Age: 8.0
Sex: F
Vaccine: COVID19
Symptoms: Cold sweat, Dizziness, Pallor, Vomiting
Clinical narrative: Minutes after shot, became pale, clammy, light headed and vomited several time
Age: 5.0
Sex: F
Vaccine: COVID19
Symptoms: Immunisation, No adverse event, Wrong technique in product usage process
Clinical narrative: Patient received a dose of Pfizer COVID-19Vaccine  Peds formulation (5-11yr) that may have been reconstituted with a single use vial of 0.9%NS that was entered into multiple times to reconstitute other vials of Pfizer vaccine. Staff did not realize the 10mL vial  was for single use only (to take out 1.3mL then discard). Each time the vial was used it was swabbed with alcohol and a new syringe was used to enter the vial then to add the diluent to the Pfizer vaccine for reconstitution. The 10mL ,  0.9%NS vial was disposed of at the end of each day. The patient did not experience any adverse reaction. At the recommendation of Pfizer and the CDC, due to lack of stability data, it was advised to revaccinate the patient.
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Anaemia, Blood test, Extra dose administered, Lymph node pain, Lymphadenopathy
Clinical narrative: Pt. states that after receiving the 3rd dose of Phizer 12/07/2021, started experiencing symptoms 12/08/2021 of swelling in the (Left) lymphnoid and slight pain. Primary visit 12/13/2021 Blood Work = Anemia. Ultrasound Appt. 12/31/2021. Pt. still continuing to experience symptoms.
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Ultrasound scan
Clinical narrative: Pt. states that after receiving the 3rd dose of Phizer 12/07/2021, started experiencing symptoms 12/08/2021 of swelling in the (Left) lymphnoid and slight pain. Primary visit 12/13/2021 Blood Work = Anemia. Ultrasound Appt. 12/31/2021. Pt. still continuing to experience symptoms.
Age: 40.0
Sex: M
Vaccine: COVID19
Symptoms: Chest discomfort, Chills, Dyspnoea, Lymphadenopathy, Pain in extremity
Clinical narrative: severe arm pain, swollen lymph node in armpit, chills, shortness of breath, tightness in chest. All started the morning after the booster and subsided within 24 hours.   I had no side effects at all for first 2 doses (Pfizer as well)
Age: 53.0
Sex: U
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: Administration error, given past beyond use date, no adverse event associated
Age: 81.0
Sex: M
Vaccine: COVID19
Symptoms: Asthenia, COVID-19, Diarrhoea, Fatigue, Inappropriate schedule of product administration
Clinical narrative: Hospitilization, weakness, malaise, body aches, fatigue, diarrhea, unknown onset of symptoms
Age: 81.0
Sex: M
Vaccine: COVID19
Symptoms: Malaise, Pain, SARS-CoV-2 test positive
Clinical narrative: Hospitilization, weakness, malaise, body aches, fatigue, diarrhea, unknown onset of symptoms
Age: 47.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: I contracted COVID-19. I experienced fatigue and mild congestion, which lasted for about 3 days.
Age: 55.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Fatigue, Headache, Influenza like illness, Pyrexia
Clinical narrative: Flu-like symptoms 12 hours after the 2nd dose of the Moderna vaccine.  Fever, headache, fatigue
Age: 28.0
Sex: F
Vaccine: COVID19
Symptoms: Angina pectoris, Respiratory disorder
Clinical narrative: Heart pain, breathing issues
Age: 35.0
Sex: F
Vaccine: COVID19
Symptoms: Extra dose administered, No adverse event
Clinical narrative: No adverse event reported. 3rd dose of Moderna administered accidentally as booster before Moderna boosters were approved for administration.
Age: 58.0
Sex: U
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: Given past beyond use date, no adverse event associated.
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Feeling hot, Muscular weakness, Pain, Tenderness
Clinical narrative: Soreness,hot,tender to touch, radiates down the arm,tender to lay on or touch,muscle weakness
Age: 41.0
Sex: U
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: Administration error, given past beyond use date, no adverse event associated
Age: 67.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: COVID-19, Dyspnoea, Positive airway pressure therapy, Productive cough, SARS-CoV-2 test positive
Clinical narrative: Pt complaining of shortness of breath and productive cough.  She has a history of diabetes mellitus.  Pt COVID positive and requiring BIPAP for respiratory support.
Age: 38.0
Sex: F
Vaccine: COVID19
Symptoms: Lymph node pain, Lymphadenopathy, Pain
Clinical narrative: axillary lymph node swelling, body aches and supraclavicular lymph node tenderness
Age: 35.0
Sex: F
Vaccine: COVID19
Symptoms: Herpes zoster, Pain
Clinical narrative: I got shingles
Age: 86.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Acute kidney injury, Acute myocardial infarction, Acute respiratory failure, Anticoagulant therapy, Anxiety
Clinical narrative: 11/22/2021:  Patient tested positive for COVID in outpatient/community setting 11/23/2021:  given Casirivimab-Imdevimab dose in outpatient/community setting 11/24/21 @0100:  Presented to ER post fall with head laceration.  Noted to have SBP 80's, MAP <50, RR 30-40, HR 130-140, sat 73% on RA with respiratory distress on movement and accessory muscle use at rest.  Rapidly declining status required intubation in the ER.  BUN Crt 29/1.4, EGFR 51, WBC 15.7, CRP 8.3, troponin 0.210, glucose 304, ABG 7.331/35/143/18.5/BE -6.7 sat 100% on Bilevel vent settings 30/10 PS 20 FiO2 100%.  EKG shows new depression in inferiolateral leads.  CXR diffuse interstitial opacities consistent with COVID 19 PNA.  Admitted with acute hypox hypoxemic respiratory failure in the setting of bilateral COVID 19 PNA, septic shock, AKI, and NSTEMI with troponin peak of 0.483.  Started on IV Rocephin, IV doxycycline, methylprednisolone, baricitinip, levophed, IVF, ASA, and heparin gtt. 11/26/21:  Heparin gtt changed to Lovenox.  Bilevel 14 20/8 Fio2 80% WBC 24.2.  FMS placed for diarrhea c.diff negative.  Levophed weaned down to maintain MAP >65 SBP >100.   11/30/21:  Started PSV weaning trials in am.  Extubated in PM to 4LNC.  After a few hours post extubation required 8L via NC to maintain sat >90%. RR 20's  12/1/21:  Increase to 10L via HFNC RR 30's HR 120's.  Patient wished to have code status changed from full code to DNR/DNI with trial BiPaP. 12/2/21:  15L via HFNC with intermittent BiPap 14/8 FiO2 70% to rest.  RR 30-40 HR 110-120 anxious and dyspnic with any activity or movement 12/3/21:  Requiring BiPap at all times 100% FiO2.  Increased  respiratory distress and anxiety.  Family meeting with patient held.  Decided on comfort care measures only.  Placed on 4L NC, morphine and ativan gtt for comfort. 12/6/21 @2330 patient expired on comfort measures.
Age: 86.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Blood creatinine increased, Blood gases, Blood glucose increased, Blood urea increased, C-reactive protein increased
Clinical narrative: 11/22/2021:  Patient tested positive for COVID in outpatient/community setting 11/23/2021:  given Casirivimab-Imdevimab dose in outpatient/community setting 11/24/21 @0100:  Presented to ER post fall with head laceration.  Noted to have SBP 80's, MAP <50, RR 30-40, HR 130-140, sat 73% on RA with respiratory distress on movement and accessory muscle use at rest.  Rapidly declining status required intubation in the ER.  BUN Crt 29/1.4, EGFR 51, WBC 15.7, CRP 8.3, troponin 0.210, glucose 304, ABG 7.331/35/143/18.5/BE -6.7 sat 100% on Bilevel vent settings 30/10 PS 20 FiO2 100%.  EKG shows new depression in inferiolateral leads.  CXR diffuse interstitial opacities consistent with COVID 19 PNA.  Admitted with acute hypox hypoxemic respiratory failure in the setting of bilateral COVID 19 PNA, septic shock, AKI, and NSTEMI with troponin peak of 0.483.  Started on IV Rocephin, IV doxycycline, methylprednisolone, baricitinip, levophed, IVF, ASA, and heparin gtt. 11/26/21:  Heparin gtt changed to Lovenox.  Bilevel 14 20/8 Fio2 80% WBC 24.2.  FMS placed for diarrhea c.diff negative.  Levophed weaned down to maintain MAP >65 SBP >100.   11/30/21:  Started PSV weaning trials in am.  Extubated in PM to 4LNC.  After a few hours post extubation required 8L via NC to maintain sat >90%. RR 20's  12/1/21:  Increase to 10L via HFNC RR 30's HR 120's.  Patient wished to have code status changed from full code to DNR/DNI with trial BiPaP. 12/2/21:  15L via HFNC with intermittent BiPap 14/8 FiO2 70% to rest.  RR 30-40 HR 110-120 anxious and dyspnic with any activity or movement 12/3/21:  Requiring BiPap at all times 100% FiO2.  Increased  respiratory distress and anxiety.  Family meeting with patient held.  Decided on comfort care measures only.  Placed on 4L NC, morphine and ativan gtt for comfort. 12/6/21 @2330 patient expired on comfort measures.
Age: 86.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Clostridium test negative, Death
Clinical narrative: 11/22/2021:  Patient tested positive for COVID in outpatient/community setting 11/23/2021:  given Casirivimab-Imdevimab dose in outpatient/community setting 11/24/21 @0100:  Presented to ER post fall with head laceration.  Noted to have SBP 80's, MAP <50, RR 30-40, HR 130-140, sat 73% on RA with respiratory distress on movement and accessory muscle use at rest.  Rapidly declining status required intubation in the ER.  BUN Crt 29/1.4, EGFR 51, WBC 15.7, CRP 8.3, troponin 0.210, glucose 304, ABG 7.331/35/143/18.5/BE -6.7 sat 100% on Bilevel vent settings 30/10 PS 20 FiO2 100%.  EKG shows new depression in inferiolateral leads.  CXR diffuse interstitial opacities consistent with COVID 19 PNA.  Admitted with acute hypox hypoxemic respiratory failure in the setting of bilateral COVID 19 PNA, septic shock, AKI, and NSTEMI with troponin peak of 0.483.  Started on IV Rocephin, IV doxycycline, methylprednisolone, baricitinip, levophed, IVF, ASA, and heparin gtt. 11/26/21:  Heparin gtt changed to Lovenox.  Bilevel 14 20/8 Fio2 80% WBC 24.2.  FMS placed for diarrhea c.diff negative.  Levophed weaned down to maintain MAP >65 SBP >100.   11/30/21:  Started PSV weaning trials in am.  Extubated in PM to 4LNC.  After a few hours post extubation required 8L via NC to maintain sat >90%. RR 20's  12/1/21:  Increase to 10L via HFNC RR 30's HR 120's.  Patient wished to have code status changed from full code to DNR/DNI with trial BiPaP. 12/2/21:  15L via HFNC with intermittent BiPap 14/8 FiO2 70% to rest.  RR 30-40 HR 110-120 anxious and dyspnic with any activity or movement 12/3/21:  Requiring BiPap at all times 100% FiO2.  Increased  respiratory distress and anxiety.  Family meeting with patient held.  Decided on comfort care measures only.  Placed on 4L NC, morphine and ativan gtt for comfort. 12/6/21 @2330 patient expired on comfort measures.