chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 84.0
Sex: F
Vaccine: COVID19-2
Symptoms: Blood glucose increased, COVID-19, Chest X-ray normal, Chest pain, Chills
Clinical narrative: Patient is a 84 y.o. female patient of a MD with history of CADm HF, CKD stage 4, hepatic cirrhosis and splenomegaly, hx GIB w/ PUD 7/2022, influenza A infection in December 2022 presented to a local Hospital on 3/13/2023 with complaints of polyuria.  Found to have mild hypoxia, COVID-19 infection  Acute respiratory failure with hypoxia Covid-19 Virus Infection Date of onset of symptoms: 3/10/2023 Symptoms present on admission: Myalgia, generalized weakness, chills Date of covid positive test: 3/13/2023 Vaccination status: vaccinated Imaging: Chest x-ray?no infiltrate or fluid overload Oxygen requirements on admission: 89% on room air, 94% on 2 L nasal cannula Current oxygen requirements: RA Medical therapy: steroids Consultants following: ID consulted Anticipated special isolation end date: 3/23/2023 Doing well, still c/o weakness but stable respiratory status off O2.   Chest pain Self limiting CP. Resolved at present. H/o CAD s/p LHC 1/4/22 with PCI On ASA, Plavix, Coreg and statin EKG showing new QT/ QRS prolongation 03/15, improving Had chronically elevated troponin in the setting of CKD, stable Has repeat episodes of chest pain since 3 days on 3/18.  EKG without any acute changes, troponins mildly elevated. Cardiology consult.GDMT in place including dual antiplatelet therapy.  Suspect her chest pain may be related to underlying COVID infection or other noncardiac etiology. Rec adding Imdur to GDMT. F/U with primary cardiologist as OP in 2-4 weeks   AKI on CKD stage III/IV  Cr 1.66, Baseline creatinine 1.1-1.3, GFR 45 Very cautious IV hydration in setting of COVID-19. Improved with IVF Cr 1.65> 1.2>1.5 today. Reduce Bumex on dc and start in 2 days with BMP on 3/23. Rec OP f/u with PCP in 1 week.    Hyperglycemia H/o DM but not on medication A1c 6.5, most likely elevated BS secondary to dexamethasone. BS should improve off steroids, will dc on low dose januvia X 1 month. OP f/u with PCP   Pancytopenia Likely infection induced Monitor; If no improvement, consider outpatient hematology follow up Stable for now.  Hypothyroidism Resume synthroid 175 mcg / day    CAD Chronic diastolic HF (congestive) Pulmonary HTN S/P staged PCI 12/30/21 and 1/4/22 after NSTEMI F/w Dr. (Cardio) Resume home regimen: aspirin 81, Lipitor 80, Plavix 75 mg daily, coreg 25 mg BID, Amlodipine 5>10 mg daily Resume Bumex at lower dose and rec OP f/u with PCP    Chronic pain Norco 5/325 every 6 hours as needed resumed   Hx GIB Hx PUD (7/2022) Resuming protonix 40 mg twice daily x 8 weeks (7/18/22-9/18/22), then daily 10/2022. Currently on PPI BID   Dementia w/o behavioral disturbances Currently alert awake oriented x3 Initiate delirium precautions Home regimen: Abilify, Prozac 20 mg daily, Atarax 25 mg 3 times daily as needed, Ditropan
Age: 84.0
Sex: F
Vaccine: COVID19-2
Symptoms: Delirium, Dementia, Electrocardiogram QRS complex prolonged, Electrocardiogram QT prolonged, Glomerular filtration rate decreased
Clinical narrative: Patient is a 84 y.o. female patient of a MD with history of CADm HF, CKD stage 4, hepatic cirrhosis and splenomegaly, hx GIB w/ PUD 7/2022, influenza A infection in December 2022 presented to a local Hospital on 3/13/2023 with complaints of polyuria.  Found to have mild hypoxia, COVID-19 infection  Acute respiratory failure with hypoxia Covid-19 Virus Infection Date of onset of symptoms: 3/10/2023 Symptoms present on admission: Myalgia, generalized weakness, chills Date of covid positive test: 3/13/2023 Vaccination status: vaccinated Imaging: Chest x-ray?no infiltrate or fluid overload Oxygen requirements on admission: 89% on room air, 94% on 2 L nasal cannula Current oxygen requirements: RA Medical therapy: steroids Consultants following: ID consulted Anticipated special isolation end date: 3/23/2023 Doing well, still c/o weakness but stable respiratory status off O2.   Chest pain Self limiting CP. Resolved at present. H/o CAD s/p LHC 1/4/22 with PCI On ASA, Plavix, Coreg and statin EKG showing new QT/ QRS prolongation 03/15, improving Had chronically elevated troponin in the setting of CKD, stable Has repeat episodes of chest pain since 3 days on 3/18.  EKG without any acute changes, troponins mildly elevated. Cardiology consult.GDMT in place including dual antiplatelet therapy.  Suspect her chest pain may be related to underlying COVID infection or other noncardiac etiology. Rec adding Imdur to GDMT. F/U with primary cardiologist as OP in 2-4 weeks   AKI on CKD stage III/IV  Cr 1.66, Baseline creatinine 1.1-1.3, GFR 45 Very cautious IV hydration in setting of COVID-19. Improved with IVF Cr 1.65> 1.2>1.5 today. Reduce Bumex on dc and start in 2 days with BMP on 3/23. Rec OP f/u with PCP in 1 week.    Hyperglycemia H/o DM but not on medication A1c 6.5, most likely elevated BS secondary to dexamethasone. BS should improve off steroids, will dc on low dose januvia X 1 month. OP f/u with PCP   Pancytopenia Likely infection induced Monitor; If no improvement, consider outpatient hematology follow up Stable for now.  Hypothyroidism Resume synthroid 175 mcg / day    CAD Chronic diastolic HF (congestive) Pulmonary HTN S/P staged PCI 12/30/21 and 1/4/22 after NSTEMI F/w Dr. (Cardio) Resume home regimen: aspirin 81, Lipitor 80, Plavix 75 mg daily, coreg 25 mg BID, Amlodipine 5>10 mg daily Resume Bumex at lower dose and rec OP f/u with PCP    Chronic pain Norco 5/325 every 6 hours as needed resumed   Hx GIB Hx PUD (7/2022) Resuming protonix 40 mg twice daily x 8 weeks (7/18/22-9/18/22), then daily 10/2022. Currently on PPI BID   Dementia w/o behavioral disturbances Currently alert awake oriented x3 Initiate delirium precautions Home regimen: Abilify, Prozac 20 mg daily, Atarax 25 mg 3 times daily as needed, Ditropan
Age: 84.0
Sex: F
Vaccine: COVID19-2
Symptoms: Glycosylated haemoglobin normal, Hyperglycaemia, Hypothyroidism, Hypoxia, Influenza
Clinical narrative: Patient is a 84 y.o. female patient of a MD with history of CADm HF, CKD stage 4, hepatic cirrhosis and splenomegaly, hx GIB w/ PUD 7/2022, influenza A infection in December 2022 presented to a local Hospital on 3/13/2023 with complaints of polyuria.  Found to have mild hypoxia, COVID-19 infection  Acute respiratory failure with hypoxia Covid-19 Virus Infection Date of onset of symptoms: 3/10/2023 Symptoms present on admission: Myalgia, generalized weakness, chills Date of covid positive test: 3/13/2023 Vaccination status: vaccinated Imaging: Chest x-ray?no infiltrate or fluid overload Oxygen requirements on admission: 89% on room air, 94% on 2 L nasal cannula Current oxygen requirements: RA Medical therapy: steroids Consultants following: ID consulted Anticipated special isolation end date: 3/23/2023 Doing well, still c/o weakness but stable respiratory status off O2.   Chest pain Self limiting CP. Resolved at present. H/o CAD s/p LHC 1/4/22 with PCI On ASA, Plavix, Coreg and statin EKG showing new QT/ QRS prolongation 03/15, improving Had chronically elevated troponin in the setting of CKD, stable Has repeat episodes of chest pain since 3 days on 3/18.  EKG without any acute changes, troponins mildly elevated. Cardiology consult.GDMT in place including dual antiplatelet therapy.  Suspect her chest pain may be related to underlying COVID infection or other noncardiac etiology. Rec adding Imdur to GDMT. F/U with primary cardiologist as OP in 2-4 weeks   AKI on CKD stage III/IV  Cr 1.66, Baseline creatinine 1.1-1.3, GFR 45 Very cautious IV hydration in setting of COVID-19. Improved with IVF Cr 1.65> 1.2>1.5 today. Reduce Bumex on dc and start in 2 days with BMP on 3/23. Rec OP f/u with PCP in 1 week.    Hyperglycemia H/o DM but not on medication A1c 6.5, most likely elevated BS secondary to dexamethasone. BS should improve off steroids, will dc on low dose januvia X 1 month. OP f/u with PCP   Pancytopenia Likely infection induced Monitor; If no improvement, consider outpatient hematology follow up Stable for now.  Hypothyroidism Resume synthroid 175 mcg / day    CAD Chronic diastolic HF (congestive) Pulmonary HTN S/P staged PCI 12/30/21 and 1/4/22 after NSTEMI F/w Dr. (Cardio) Resume home regimen: aspirin 81, Lipitor 80, Plavix 75 mg daily, coreg 25 mg BID, Amlodipine 5>10 mg daily Resume Bumex at lower dose and rec OP f/u with PCP    Chronic pain Norco 5/325 every 6 hours as needed resumed   Hx GIB Hx PUD (7/2022) Resuming protonix 40 mg twice daily x 8 weeks (7/18/22-9/18/22), then daily 10/2022. Currently on PPI BID   Dementia w/o behavioral disturbances Currently alert awake oriented x3 Initiate delirium precautions Home regimen: Abilify, Prozac 20 mg daily, Atarax 25 mg 3 times daily as needed, Ditropan
Age: 84.0
Sex: F
Vaccine: COVID19-2
Symptoms: Myalgia, Pancytopenia, Polyuria, SARS-CoV-2 test positive, Troponin increased
Clinical narrative: Patient is a 84 y.o. female patient of a MD with history of CADm HF, CKD stage 4, hepatic cirrhosis and splenomegaly, hx GIB w/ PUD 7/2022, influenza A infection in December 2022 presented to a local Hospital on 3/13/2023 with complaints of polyuria.  Found to have mild hypoxia, COVID-19 infection  Acute respiratory failure with hypoxia Covid-19 Virus Infection Date of onset of symptoms: 3/10/2023 Symptoms present on admission: Myalgia, generalized weakness, chills Date of covid positive test: 3/13/2023 Vaccination status: vaccinated Imaging: Chest x-ray?no infiltrate or fluid overload Oxygen requirements on admission: 89% on room air, 94% on 2 L nasal cannula Current oxygen requirements: RA Medical therapy: steroids Consultants following: ID consulted Anticipated special isolation end date: 3/23/2023 Doing well, still c/o weakness but stable respiratory status off O2.   Chest pain Self limiting CP. Resolved at present. H/o CAD s/p LHC 1/4/22 with PCI On ASA, Plavix, Coreg and statin EKG showing new QT/ QRS prolongation 03/15, improving Had chronically elevated troponin in the setting of CKD, stable Has repeat episodes of chest pain since 3 days on 3/18.  EKG without any acute changes, troponins mildly elevated. Cardiology consult.GDMT in place including dual antiplatelet therapy.  Suspect her chest pain may be related to underlying COVID infection or other noncardiac etiology. Rec adding Imdur to GDMT. F/U with primary cardiologist as OP in 2-4 weeks   AKI on CKD stage III/IV  Cr 1.66, Baseline creatinine 1.1-1.3, GFR 45 Very cautious IV hydration in setting of COVID-19. Improved with IVF Cr 1.65> 1.2>1.5 today. Reduce Bumex on dc and start in 2 days with BMP on 3/23. Rec OP f/u with PCP in 1 week.    Hyperglycemia H/o DM but not on medication A1c 6.5, most likely elevated BS secondary to dexamethasone. BS should improve off steroids, will dc on low dose januvia X 1 month. OP f/u with PCP   Pancytopenia Likely infection induced Monitor; If no improvement, consider outpatient hematology follow up Stable for now.  Hypothyroidism Resume synthroid 175 mcg / day    CAD Chronic diastolic HF (congestive) Pulmonary HTN S/P staged PCI 12/30/21 and 1/4/22 after NSTEMI F/w Dr. (Cardio) Resume home regimen: aspirin 81, Lipitor 80, Plavix 75 mg daily, coreg 25 mg BID, Amlodipine 5>10 mg daily Resume Bumex at lower dose and rec OP f/u with PCP    Chronic pain Norco 5/325 every 6 hours as needed resumed   Hx GIB Hx PUD (7/2022) Resuming protonix 40 mg twice daily x 8 weeks (7/18/22-9/18/22), then daily 10/2022. Currently on PPI BID   Dementia w/o behavioral disturbances Currently alert awake oriented x3 Initiate delirium precautions Home regimen: Abilify, Prozac 20 mg daily, Atarax 25 mg 3 times daily as needed, Ditropan
Age: 87.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, COVID-19, Cardiac failure acute, Cardiac failure congestive, Chest X-ray abnormal
Clinical narrative: Patient is a 89 y.o. female patient of the MD with history of CAD s/p CABG, chronic diastolic CHF, GERD, hypertension, chronic lower extremity pain presented to the Hospital with fever, sore throat, shortness of breath and cough admitted for acute respiratory failure secondary to CHF and COVID-19 infection  Acute hypoxic respiratory failure-resolved Not on O2 at home, requiring 4 L of oxygen Shortness of breath secondary to acute on chronic CHF and COVID-19 Chest x-ray-worsening pulmonary edema and bilateral pleural effusions On IV diuretics and steroids as mentioned below Pul toilette   Acute on chronic diastolic CHF, uncompensaed CAD, s/p CABG Last echo 2/16/2023-EF 60% with grade 2 diastolic dysfunction Not on cardiac meds (patient and family does not like polypharmacy) On Lasix 10 mg as needed at home, started on Lasix 20 mg IV twice daily>changed to oral today Cardio followed and signed off,resume f/u as instructed C/w lasix 20mg daily on discharge OP Cardio fu as instructed   Covid-19 Virus Infection Date of onset of symptoms: 3/12 Symptoms present on admission: Sore throat, cough, low-grade fevers Date of covid positive test: 3/14 Vaccination status: vaccinated Imaging: Chest x-ray-pulmonary edema Oxygen requirements on admission: 4 L Current oxygen requirements: 4 L> RA Medical therapy: steroids years her EKG Consultants following: E consult to ID for Paxlovid, started on 3/15, stop on discharge Anticipated special isolation end date: 3/22  F/u with your PCP for updating your vaccination per current CDC guidelines.    Hypertension Not on meds at assisted living On amlodipine and lasix, continue on discharge Hold coreg due to bradycardia OP PCP f/u with BP log as instructed   Sinus bradycardia-resolved Stopped Coreg Stable vitals   Chronic leg cramps-stable Recent lower extremity venous Doppler negative for DVT
Age: 87.0
Sex: F
Vaccine: COVID19
Symptoms: Condition aggravated, Cough, Diastolic dysfunction, Diuretic therapy, Dyspnoea
Clinical narrative: Patient is a 89 y.o. female patient of the MD with history of CAD s/p CABG, chronic diastolic CHF, GERD, hypertension, chronic lower extremity pain presented to the Hospital with fever, sore throat, shortness of breath and cough admitted for acute respiratory failure secondary to CHF and COVID-19 infection  Acute hypoxic respiratory failure-resolved Not on O2 at home, requiring 4 L of oxygen Shortness of breath secondary to acute on chronic CHF and COVID-19 Chest x-ray-worsening pulmonary edema and bilateral pleural effusions On IV diuretics and steroids as mentioned below Pul toilette   Acute on chronic diastolic CHF, uncompensaed CAD, s/p CABG Last echo 2/16/2023-EF 60% with grade 2 diastolic dysfunction Not on cardiac meds (patient and family does not like polypharmacy) On Lasix 10 mg as needed at home, started on Lasix 20 mg IV twice daily>changed to oral today Cardio followed and signed off,resume f/u as instructed C/w lasix 20mg daily on discharge OP Cardio fu as instructed   Covid-19 Virus Infection Date of onset of symptoms: 3/12 Symptoms present on admission: Sore throat, cough, low-grade fevers Date of covid positive test: 3/14 Vaccination status: vaccinated Imaging: Chest x-ray-pulmonary edema Oxygen requirements on admission: 4 L Current oxygen requirements: 4 L> RA Medical therapy: steroids years her EKG Consultants following: E consult to ID for Paxlovid, started on 3/15, stop on discharge Anticipated special isolation end date: 3/22  F/u with your PCP for updating your vaccination per current CDC guidelines.    Hypertension Not on meds at assisted living On amlodipine and lasix, continue on discharge Hold coreg due to bradycardia OP PCP f/u with BP log as instructed   Sinus bradycardia-resolved Stopped Coreg Stable vitals   Chronic leg cramps-stable Recent lower extremity venous Doppler negative for DVT
Age: 87.0
Sex: F
Vaccine: COVID19
Symptoms: Echocardiogram abnormal, Ejection fraction decreased, Oropharyngeal pain, Pleural effusion, Pulmonary oedema
Clinical narrative: Patient is a 89 y.o. female patient of the MD with history of CAD s/p CABG, chronic diastolic CHF, GERD, hypertension, chronic lower extremity pain presented to the Hospital with fever, sore throat, shortness of breath and cough admitted for acute respiratory failure secondary to CHF and COVID-19 infection  Acute hypoxic respiratory failure-resolved Not on O2 at home, requiring 4 L of oxygen Shortness of breath secondary to acute on chronic CHF and COVID-19 Chest x-ray-worsening pulmonary edema and bilateral pleural effusions On IV diuretics and steroids as mentioned below Pul toilette   Acute on chronic diastolic CHF, uncompensaed CAD, s/p CABG Last echo 2/16/2023-EF 60% with grade 2 diastolic dysfunction Not on cardiac meds (patient and family does not like polypharmacy) On Lasix 10 mg as needed at home, started on Lasix 20 mg IV twice daily>changed to oral today Cardio followed and signed off,resume f/u as instructed C/w lasix 20mg daily on discharge OP Cardio fu as instructed   Covid-19 Virus Infection Date of onset of symptoms: 3/12 Symptoms present on admission: Sore throat, cough, low-grade fevers Date of covid positive test: 3/14 Vaccination status: vaccinated Imaging: Chest x-ray-pulmonary edema Oxygen requirements on admission: 4 L Current oxygen requirements: 4 L> RA Medical therapy: steroids years her EKG Consultants following: E consult to ID for Paxlovid, started on 3/15, stop on discharge Anticipated special isolation end date: 3/22  F/u with your PCP for updating your vaccination per current CDC guidelines.    Hypertension Not on meds at assisted living On amlodipine and lasix, continue on discharge Hold coreg due to bradycardia OP PCP f/u with BP log as instructed   Sinus bradycardia-resolved Stopped Coreg Stable vitals   Chronic leg cramps-stable Recent lower extremity venous Doppler negative for DVT
Age: 87.0
Sex: F
Vaccine: COVID19
Symptoms: Pyrexia, SARS-CoV-2 test positive, Sinus bradycardia, Ultrasound Doppler normal
Clinical narrative: Patient is a 89 y.o. female patient of the MD with history of CAD s/p CABG, chronic diastolic CHF, GERD, hypertension, chronic lower extremity pain presented to the Hospital with fever, sore throat, shortness of breath and cough admitted for acute respiratory failure secondary to CHF and COVID-19 infection  Acute hypoxic respiratory failure-resolved Not on O2 at home, requiring 4 L of oxygen Shortness of breath secondary to acute on chronic CHF and COVID-19 Chest x-ray-worsening pulmonary edema and bilateral pleural effusions On IV diuretics and steroids as mentioned below Pul toilette   Acute on chronic diastolic CHF, uncompensaed CAD, s/p CABG Last echo 2/16/2023-EF 60% with grade 2 diastolic dysfunction Not on cardiac meds (patient and family does not like polypharmacy) On Lasix 10 mg as needed at home, started on Lasix 20 mg IV twice daily>changed to oral today Cardio followed and signed off,resume f/u as instructed C/w lasix 20mg daily on discharge OP Cardio fu as instructed   Covid-19 Virus Infection Date of onset of symptoms: 3/12 Symptoms present on admission: Sore throat, cough, low-grade fevers Date of covid positive test: 3/14 Vaccination status: vaccinated Imaging: Chest x-ray-pulmonary edema Oxygen requirements on admission: 4 L Current oxygen requirements: 4 L> RA Medical therapy: steroids years her EKG Consultants following: E consult to ID for Paxlovid, started on 3/15, stop on discharge Anticipated special isolation end date: 3/22  F/u with your PCP for updating your vaccination per current CDC guidelines.    Hypertension Not on meds at assisted living On amlodipine and lasix, continue on discharge Hold coreg due to bradycardia OP PCP f/u with BP log as instructed   Sinus bradycardia-resolved Stopped Coreg Stable vitals   Chronic leg cramps-stable Recent lower extremity venous Doppler negative for DVT
Age: 13.0
Sex: F
Vaccine: COVID19
Symptoms: Angiogram cerebral normal, Angiogram normal, Aortic dilatation, COVID-19, Cerebral infarction
Clinical narrative: PT had an acute intracranial hemorrhage 4/15/23 following recent international travel, incidentally was also found to be COVID + on PCR. She was also noted to have  Mildly Dilated aortic root and ascending aorta on echo performed 4/16/2023
Age: 13.0
Sex: F
Vaccine: COVID19
Symptoms: Chest X-ray normal, Computerised tomogram head abnormal, Echocardiogram abnormal, Haemorrhage intracranial, Magnetic resonance imaging head abnormal
Clinical narrative: PT had an acute intracranial hemorrhage 4/15/23 following recent international travel, incidentally was also found to be COVID + on PCR. She was also noted to have  Mildly Dilated aortic root and ascending aorta on echo performed 4/16/2023
Age: 13.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Scan with contrast abnormal, Venogram normal
Clinical narrative: PT had an acute intracranial hemorrhage 4/15/23 following recent international travel, incidentally was also found to be COVID + on PCR. She was also noted to have  Mildly Dilated aortic root and ascending aorta on echo performed 4/16/2023
Age: 80.0
Sex: F
Vaccine: COVID19-2
Symptoms: Conjunctivitis, Eye discharge, Eye pruritus, Ocular hyperaemia, Swelling of eyelid
Clinical narrative: FIVE HOURS AFTER VACCINATION HAD STRONG SYMPTOMS OF CONJUNCTIVITIS - RED EYES, SCRATCHY, ITCHY, DISCHARGE, PUFFED UP EYELIDS
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Asthenia, Blood culture, Blood gases abnormal, Blood lactic acid, Blood pH decreased
Clinical narrative: This is a 75-year-old male with a past medical history of coronary artery disease, anxiety, bipolar 2 disorder, dementia, GERD, hypertension, type 2 diabetes mellitus, mixed hyperlipidemia, schizoaffective disorder presenting to the ED today via EMS with chief complaint of fatigue and weakness.  Patient is unable to provide HPI or ROS given the acuity of his condition.  History was provided by EMS as well as by patient's family members via telephone.  Patient reportedly has had poor and increasingly worsening neurocognitive decline recently.  He recently tested positive for COVID and was found to be lethargic and poorly responsive at the nursing home earlier today.  Upon his arrival here to the ED he has tachypneic breathing with pale cool skin and overall ill-appearing.  2+ radial pulses bilaterally.  No signs of trauma.  Paperwork at bedside indicates that patient is DNR CC.  No further information available.  This is a 75-year-old male with a past medical history of coronary artery disease, anxiety, bipolar 2 disorder, dementia, GERD, hypertension, type 2 diabetes mellitus, mixed hyperlipidemia, schizoaffective disorder presenting to the ED today via EMS with chief complaint of fatigue and weakness.  Vital signs show a rectal temperature of 92.7 °F with a blood pressure of 94/77 and heart rate of 85 bpm.  Patient is ill-appearing with pale skin.  He has tachypneic breathing.  Cardiac sounds normal rate and rhythm.  Abdomen soft and compressible.  No bilateral lower extremity edema.  2+ radial pulse bilaterally.  Unable to assess neurological function given the acuity of his condition.  He does open his eyes to sternal rub and withdraws from painful stimuli.  His differential diagnosis includes, but is not limited to septic shock, acute respiratory failure, palliative hospitalization.  Paperwork at bedside initially indicated that patient was a DNR CC.  Attending physician did speak with patient's power of attorney and updated POA on the acuity of patient's condition.  Initially POA would like to proceed with DNR CCA.  Patient was then given IV fluids as well as bicarb as his initial VBG showed a pH of 6.97, PCO2 23.5 and PO2 of 31.  Initial lactic acid of 18.0.  We did obtain blood cultures and started patient on broad-spectrum antibiotics.  When POA arrived to the hospital, my attending physician Dr. had a discussion regarding how critically ill patient is.  Goals of care were discussed and it was decided from the family that the best interest for patient was to make him a DNR CC.  IV fluids were subsequently discontinued.  Pressors were discontinued as well.  Orders were placed for comfort care measures in addition to Ativan, morphine as needed  Was called to the bedside by RN.  Patient asystole on the monitor.  Patient without spontaneous respirations.  No pulse.  Bedside ultrasound shows no cardiac activity.   Time of death 238.  Comfort provided to family at bedside
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Body temperature decreased, COVID-19, Cognitive disorder, Death, Echocardiogram abnormal
Clinical narrative: This is a 75-year-old male with a past medical history of coronary artery disease, anxiety, bipolar 2 disorder, dementia, GERD, hypertension, type 2 diabetes mellitus, mixed hyperlipidemia, schizoaffective disorder presenting to the ED today via EMS with chief complaint of fatigue and weakness.  Patient is unable to provide HPI or ROS given the acuity of his condition.  History was provided by EMS as well as by patient's family members via telephone.  Patient reportedly has had poor and increasingly worsening neurocognitive decline recently.  He recently tested positive for COVID and was found to be lethargic and poorly responsive at the nursing home earlier today.  Upon his arrival here to the ED he has tachypneic breathing with pale cool skin and overall ill-appearing.  2+ radial pulses bilaterally.  No signs of trauma.  Paperwork at bedside indicates that patient is DNR CC.  No further information available.  This is a 75-year-old male with a past medical history of coronary artery disease, anxiety, bipolar 2 disorder, dementia, GERD, hypertension, type 2 diabetes mellitus, mixed hyperlipidemia, schizoaffective disorder presenting to the ED today via EMS with chief complaint of fatigue and weakness.  Vital signs show a rectal temperature of 92.7 °F with a blood pressure of 94/77 and heart rate of 85 bpm.  Patient is ill-appearing with pale skin.  He has tachypneic breathing.  Cardiac sounds normal rate and rhythm.  Abdomen soft and compressible.  No bilateral lower extremity edema.  2+ radial pulse bilaterally.  Unable to assess neurological function given the acuity of his condition.  He does open his eyes to sternal rub and withdraws from painful stimuli.  His differential diagnosis includes, but is not limited to septic shock, acute respiratory failure, palliative hospitalization.  Paperwork at bedside initially indicated that patient was a DNR CC.  Attending physician did speak with patient's power of attorney and updated POA on the acuity of patient's condition.  Initially POA would like to proceed with DNR CCA.  Patient was then given IV fluids as well as bicarb as his initial VBG showed a pH of 6.97, PCO2 23.5 and PO2 of 31.  Initial lactic acid of 18.0.  We did obtain blood cultures and started patient on broad-spectrum antibiotics.  When POA arrived to the hospital, my attending physician Dr. had a discussion regarding how critically ill patient is.  Goals of care were discussed and it was decided from the family that the best interest for patient was to make him a DNR CC.  IV fluids were subsequently discontinued.  Pressors were discontinued as well.  Orders were placed for comfort care measures in addition to Ativan, morphine as needed  Was called to the bedside by RN.  Patient asystole on the monitor.  Patient without spontaneous respirations.  No pulse.  Bedside ultrasound shows no cardiac activity.   Time of death 238.  Comfort provided to family at bedside
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Fatigue, Heart sounds normal, Hyporesponsive to stimuli, Lethargy, PCO2 decreased
Clinical narrative: This is a 75-year-old male with a past medical history of coronary artery disease, anxiety, bipolar 2 disorder, dementia, GERD, hypertension, type 2 diabetes mellitus, mixed hyperlipidemia, schizoaffective disorder presenting to the ED today via EMS with chief complaint of fatigue and weakness.  Patient is unable to provide HPI or ROS given the acuity of his condition.  History was provided by EMS as well as by patient's family members via telephone.  Patient reportedly has had poor and increasingly worsening neurocognitive decline recently.  He recently tested positive for COVID and was found to be lethargic and poorly responsive at the nursing home earlier today.  Upon his arrival here to the ED he has tachypneic breathing with pale cool skin and overall ill-appearing.  2+ radial pulses bilaterally.  No signs of trauma.  Paperwork at bedside indicates that patient is DNR CC.  No further information available.  This is a 75-year-old male with a past medical history of coronary artery disease, anxiety, bipolar 2 disorder, dementia, GERD, hypertension, type 2 diabetes mellitus, mixed hyperlipidemia, schizoaffective disorder presenting to the ED today via EMS with chief complaint of fatigue and weakness.  Vital signs show a rectal temperature of 92.7 °F with a blood pressure of 94/77 and heart rate of 85 bpm.  Patient is ill-appearing with pale skin.  He has tachypneic breathing.  Cardiac sounds normal rate and rhythm.  Abdomen soft and compressible.  No bilateral lower extremity edema.  2+ radial pulse bilaterally.  Unable to assess neurological function given the acuity of his condition.  He does open his eyes to sternal rub and withdraws from painful stimuli.  His differential diagnosis includes, but is not limited to septic shock, acute respiratory failure, palliative hospitalization.  Paperwork at bedside initially indicated that patient was a DNR CC.  Attending physician did speak with patient's power of attorney and updated POA on the acuity of patient's condition.  Initially POA would like to proceed with DNR CCA.  Patient was then given IV fluids as well as bicarb as his initial VBG showed a pH of 6.97, PCO2 23.5 and PO2 of 31.  Initial lactic acid of 18.0.  We did obtain blood cultures and started patient on broad-spectrum antibiotics.  When POA arrived to the hospital, my attending physician Dr. had a discussion regarding how critically ill patient is.  Goals of care were discussed and it was decided from the family that the best interest for patient was to make him a DNR CC.  IV fluids were subsequently discontinued.  Pressors were discontinued as well.  Orders were placed for comfort care measures in addition to Ativan, morphine as needed  Was called to the bedside by RN.  Patient asystole on the monitor.  Patient without spontaneous respirations.  No pulse.  Bedside ultrasound shows no cardiac activity.   Time of death 238.  Comfort provided to family at bedside
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: PO2 decreased, Pallor, Peripheral coldness, Pulse absent, SARS-CoV-2 test positive
Clinical narrative: This is a 75-year-old male with a past medical history of coronary artery disease, anxiety, bipolar 2 disorder, dementia, GERD, hypertension, type 2 diabetes mellitus, mixed hyperlipidemia, schizoaffective disorder presenting to the ED today via EMS with chief complaint of fatigue and weakness.  Patient is unable to provide HPI or ROS given the acuity of his condition.  History was provided by EMS as well as by patient's family members via telephone.  Patient reportedly has had poor and increasingly worsening neurocognitive decline recently.  He recently tested positive for COVID and was found to be lethargic and poorly responsive at the nursing home earlier today.  Upon his arrival here to the ED he has tachypneic breathing with pale cool skin and overall ill-appearing.  2+ radial pulses bilaterally.  No signs of trauma.  Paperwork at bedside indicates that patient is DNR CC.  No further information available.  This is a 75-year-old male with a past medical history of coronary artery disease, anxiety, bipolar 2 disorder, dementia, GERD, hypertension, type 2 diabetes mellitus, mixed hyperlipidemia, schizoaffective disorder presenting to the ED today via EMS with chief complaint of fatigue and weakness.  Vital signs show a rectal temperature of 92.7 °F with a blood pressure of 94/77 and heart rate of 85 bpm.  Patient is ill-appearing with pale skin.  He has tachypneic breathing.  Cardiac sounds normal rate and rhythm.  Abdomen soft and compressible.  No bilateral lower extremity edema.  2+ radial pulse bilaterally.  Unable to assess neurological function given the acuity of his condition.  He does open his eyes to sternal rub and withdraws from painful stimuli.  His differential diagnosis includes, but is not limited to septic shock, acute respiratory failure, palliative hospitalization.  Paperwork at bedside initially indicated that patient was a DNR CC.  Attending physician did speak with patient's power of attorney and updated POA on the acuity of patient's condition.  Initially POA would like to proceed with DNR CCA.  Patient was then given IV fluids as well as bicarb as his initial VBG showed a pH of 6.97, PCO2 23.5 and PO2 of 31.  Initial lactic acid of 18.0.  We did obtain blood cultures and started patient on broad-spectrum antibiotics.  When POA arrived to the hospital, my attending physician Dr. had a discussion regarding how critically ill patient is.  Goals of care were discussed and it was decided from the family that the best interest for patient was to make him a DNR CC.  IV fluids were subsequently discontinued.  Pressors were discontinued as well.  Orders were placed for comfort care measures in addition to Ativan, morphine as needed  Was called to the bedside by RN.  Patient asystole on the monitor.  Patient without spontaneous respirations.  No pulse.  Bedside ultrasound shows no cardiac activity.   Time of death 238.  Comfort provided to family at bedside
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Tachypnoea
Clinical narrative: This is a 75-year-old male with a past medical history of coronary artery disease, anxiety, bipolar 2 disorder, dementia, GERD, hypertension, type 2 diabetes mellitus, mixed hyperlipidemia, schizoaffective disorder presenting to the ED today via EMS with chief complaint of fatigue and weakness.  Patient is unable to provide HPI or ROS given the acuity of his condition.  History was provided by EMS as well as by patient's family members via telephone.  Patient reportedly has had poor and increasingly worsening neurocognitive decline recently.  He recently tested positive for COVID and was found to be lethargic and poorly responsive at the nursing home earlier today.  Upon his arrival here to the ED he has tachypneic breathing with pale cool skin and overall ill-appearing.  2+ radial pulses bilaterally.  No signs of trauma.  Paperwork at bedside indicates that patient is DNR CC.  No further information available.  This is a 75-year-old male with a past medical history of coronary artery disease, anxiety, bipolar 2 disorder, dementia, GERD, hypertension, type 2 diabetes mellitus, mixed hyperlipidemia, schizoaffective disorder presenting to the ED today via EMS with chief complaint of fatigue and weakness.  Vital signs show a rectal temperature of 92.7 °F with a blood pressure of 94/77 and heart rate of 85 bpm.  Patient is ill-appearing with pale skin.  He has tachypneic breathing.  Cardiac sounds normal rate and rhythm.  Abdomen soft and compressible.  No bilateral lower extremity edema.  2+ radial pulse bilaterally.  Unable to assess neurological function given the acuity of his condition.  He does open his eyes to sternal rub and withdraws from painful stimuli.  His differential diagnosis includes, but is not limited to septic shock, acute respiratory failure, palliative hospitalization.  Paperwork at bedside initially indicated that patient was a DNR CC.  Attending physician did speak with patient's power of attorney and updated POA on the acuity of patient's condition.  Initially POA would like to proceed with DNR CCA.  Patient was then given IV fluids as well as bicarb as his initial VBG showed a pH of 6.97, PCO2 23.5 and PO2 of 31.  Initial lactic acid of 18.0.  We did obtain blood cultures and started patient on broad-spectrum antibiotics.  When POA arrived to the hospital, my attending physician Dr. had a discussion regarding how critically ill patient is.  Goals of care were discussed and it was decided from the family that the best interest for patient was to make him a DNR CC.  IV fluids were subsequently discontinued.  Pressors were discontinued as well.  Orders were placed for comfort care measures in addition to Ativan, morphine as needed  Was called to the bedside by RN.  Patient asystole on the monitor.  Patient without spontaneous respirations.  No pulse.  Bedside ultrasound shows no cardiac activity.   Time of death 238.  Comfort provided to family at bedside
Age: 11.0
Sex: F
Vaccine: COVID19
Symptoms: No adverse event, Product administered to patient of inappropriate age, Vaccination error, Wrong product administered
Clinical narrative: Patient received the 1st dose for the Pfizer gray cap series which is for 12 and up. At the time of vaccination patient was 11 years of age. Noticed the error the next day 4/16/23 and tried to contact patient but did not have a correct phone number or physical address. As of right now no adverse events reported.
Age: 50.0
Sex: M
Vaccine: VARZOS
Symptoms: Arthralgia, Chills, Headache, Malaise, Pain
Clinical narrative: Strong headache, fever, chills, body aches, joints aches, malaise.
Age: 50.0
Sex: M
Vaccine: VARZOS
Symptoms: Pyrexia
Clinical narrative: Strong headache, fever, chills, body aches, joints aches, malaise.
Age: 63.0
Sex: M
Vaccine: COVID19
Symptoms: Angiogram pulmonary abnormal, Asthenia, Bacterial test negative, Blood culture positive, Blood lactic acid
Clinical narrative: Patient is a 64 y.o. male patient of DO with history of stage IV Hodgkin lymphoma, HIV, bipolar depression, obstructive sleep apnea, GERD, chronic back pain, BPH, and hemorrhoids who presented to Hospital with weakness and diarrhea.  He was found to be covid positive on 3/17. Has been doing overall good and stable. Reached out to palliative for goals of care conversation. Patient notes he would like to be DNR CC and would like pain management with no medical management for his conditions. Hospice team has been following with patient, however, patient would like to go home for now. Discussed other options for hospice, as well as provided number for his oncology navigator who has been trying to get him established with hospice as well. At this time, stable for discharge and outpatient follow up.   Sepsis, resolved COVID 19 - 3/17 On presentation, hypertensive and tachypneic; leukopenic at 2.52; with lactic acidosis (2.4) COVID-positive Chest x-ray with possible bronchitis ED course - 30 cc/kg fluid bolus and IV Zosyn at this time Continue empiric IV Zosyn ID consulted. Appreciate input. Continue empiric antibiotics.   Palliative consulted for goals of care - Wants to focus on comfort care and is interested in utilizing support of hospice Referral to hospice placed.  Appreciate input from hospice as they formulate plan; patient requesting home hospice   Diarrhea, chronic, improved CT abdomen pelvis with mild central mesenteric edema and could indicate some form of mesenteric adenitis; as well as fluid in the proximal colon Blood cultures 1/2 with staph epi  Started on IV zosyn but discontinued after no bacterial etiology Continue IV fluids C. difficile negative Monitor   HIV infection DNR CC Last CD4 146 in December 2022 Patient was previously on Biktarvy, stopped treatment on his own Declines Biktarvy   Stage IV Hodgkin lymphoma DNR CC Diagnosed in June 2021 Underwent 5-6 cycles of chemotherapy, stopped treatment on his own WBC 2.52 CTPA with nonspecific mediastinal, right hilar, and periportal lymph nodes concerning for metastatic disease Pulmonary consulted during last admission 2 weeks ago as pt declined further therapy for his lymphoma and is not interested in further diagnostic evaluation.   Oncology consulted prior admission - Recommend PET CT scan outpatient if patient desires follow-up. Would need to follow-up back for surveillance and evaluate for recurrent disease. Palliative consulted as above.  CODE STATUS DNR CC
Age: 63.0
Sex: M
Vaccine: COVID19
Symptoms: CD4 lymphocytes increased, COVID-19, Chest X-ray abnormal, Clostridium test, Computerised tomogram abdomen abnormal
Clinical narrative: Patient is a 64 y.o. male patient of DO with history of stage IV Hodgkin lymphoma, HIV, bipolar depression, obstructive sleep apnea, GERD, chronic back pain, BPH, and hemorrhoids who presented to Hospital with weakness and diarrhea.  He was found to be covid positive on 3/17. Has been doing overall good and stable. Reached out to palliative for goals of care conversation. Patient notes he would like to be DNR CC and would like pain management with no medical management for his conditions. Hospice team has been following with patient, however, patient would like to go home for now. Discussed other options for hospice, as well as provided number for his oncology navigator who has been trying to get him established with hospice as well. At this time, stable for discharge and outpatient follow up.   Sepsis, resolved COVID 19 - 3/17 On presentation, hypertensive and tachypneic; leukopenic at 2.52; with lactic acidosis (2.4) COVID-positive Chest x-ray with possible bronchitis ED course - 30 cc/kg fluid bolus and IV Zosyn at this time Continue empiric IV Zosyn ID consulted. Appreciate input. Continue empiric antibiotics.   Palliative consulted for goals of care - Wants to focus on comfort care and is interested in utilizing support of hospice Referral to hospice placed.  Appreciate input from hospice as they formulate plan; patient requesting home hospice   Diarrhea, chronic, improved CT abdomen pelvis with mild central mesenteric edema and could indicate some form of mesenteric adenitis; as well as fluid in the proximal colon Blood cultures 1/2 with staph epi  Started on IV zosyn but discontinued after no bacterial etiology Continue IV fluids C. difficile negative Monitor   HIV infection DNR CC Last CD4 146 in December 2022 Patient was previously on Biktarvy, stopped treatment on his own Declines Biktarvy   Stage IV Hodgkin lymphoma DNR CC Diagnosed in June 2021 Underwent 5-6 cycles of chemotherapy, stopped treatment on his own WBC 2.52 CTPA with nonspecific mediastinal, right hilar, and periportal lymph nodes concerning for metastatic disease Pulmonary consulted during last admission 2 weeks ago as pt declined further therapy for his lymphoma and is not interested in further diagnostic evaluation.   Oncology consulted prior admission - Recommend PET CT scan outpatient if patient desires follow-up. Would need to follow-up back for surveillance and evaluate for recurrent disease. Palliative consulted as above.  CODE STATUS DNR CC
Age: 63.0
Sex: M
Vaccine: COVID19
Symptoms: Diarrhoea, Gastrointestinal oedema, HIV infection, Hodgkin's disease, Hypertension
Clinical narrative: Patient is a 64 y.o. male patient of DO with history of stage IV Hodgkin lymphoma, HIV, bipolar depression, obstructive sleep apnea, GERD, chronic back pain, BPH, and hemorrhoids who presented to Hospital with weakness and diarrhea.  He was found to be covid positive on 3/17. Has been doing overall good and stable. Reached out to palliative for goals of care conversation. Patient notes he would like to be DNR CC and would like pain management with no medical management for his conditions. Hospice team has been following with patient, however, patient would like to go home for now. Discussed other options for hospice, as well as provided number for his oncology navigator who has been trying to get him established with hospice as well. At this time, stable for discharge and outpatient follow up.   Sepsis, resolved COVID 19 - 3/17 On presentation, hypertensive and tachypneic; leukopenic at 2.52; with lactic acidosis (2.4) COVID-positive Chest x-ray with possible bronchitis ED course - 30 cc/kg fluid bolus and IV Zosyn at this time Continue empiric IV Zosyn ID consulted. Appreciate input. Continue empiric antibiotics.   Palliative consulted for goals of care - Wants to focus on comfort care and is interested in utilizing support of hospice Referral to hospice placed.  Appreciate input from hospice as they formulate plan; patient requesting home hospice   Diarrhea, chronic, improved CT abdomen pelvis with mild central mesenteric edema and could indicate some form of mesenteric adenitis; as well as fluid in the proximal colon Blood cultures 1/2 with staph epi  Started on IV zosyn but discontinued after no bacterial etiology Continue IV fluids C. difficile negative Monitor   HIV infection DNR CC Last CD4 146 in December 2022 Patient was previously on Biktarvy, stopped treatment on his own Declines Biktarvy   Stage IV Hodgkin lymphoma DNR CC Diagnosed in June 2021 Underwent 5-6 cycles of chemotherapy, stopped treatment on his own WBC 2.52 CTPA with nonspecific mediastinal, right hilar, and periportal lymph nodes concerning for metastatic disease Pulmonary consulted during last admission 2 weeks ago as pt declined further therapy for his lymphoma and is not interested in further diagnostic evaluation.   Oncology consulted prior admission - Recommend PET CT scan outpatient if patient desires follow-up. Would need to follow-up back for surveillance and evaluate for recurrent disease. Palliative consulted as above.  CODE STATUS DNR CC
Age: 63.0
Sex: M
Vaccine: COVID19
Symptoms: Lactic acidosis, Leukopenia, Lymphadenopathy, SARS-CoV-2 test positive, Sepsis
Clinical narrative: Patient is a 64 y.o. male patient of DO with history of stage IV Hodgkin lymphoma, HIV, bipolar depression, obstructive sleep apnea, GERD, chronic back pain, BPH, and hemorrhoids who presented to Hospital with weakness and diarrhea.  He was found to be covid positive on 3/17. Has been doing overall good and stable. Reached out to palliative for goals of care conversation. Patient notes he would like to be DNR CC and would like pain management with no medical management for his conditions. Hospice team has been following with patient, however, patient would like to go home for now. Discussed other options for hospice, as well as provided number for his oncology navigator who has been trying to get him established with hospice as well. At this time, stable for discharge and outpatient follow up.   Sepsis, resolved COVID 19 - 3/17 On presentation, hypertensive and tachypneic; leukopenic at 2.52; with lactic acidosis (2.4) COVID-positive Chest x-ray with possible bronchitis ED course - 30 cc/kg fluid bolus and IV Zosyn at this time Continue empiric IV Zosyn ID consulted. Appreciate input. Continue empiric antibiotics.   Palliative consulted for goals of care - Wants to focus on comfort care and is interested in utilizing support of hospice Referral to hospice placed.  Appreciate input from hospice as they formulate plan; patient requesting home hospice   Diarrhea, chronic, improved CT abdomen pelvis with mild central mesenteric edema and could indicate some form of mesenteric adenitis; as well as fluid in the proximal colon Blood cultures 1/2 with staph epi  Started on IV zosyn but discontinued after no bacterial etiology Continue IV fluids C. difficile negative Monitor   HIV infection DNR CC Last CD4 146 in December 2022 Patient was previously on Biktarvy, stopped treatment on his own Declines Biktarvy   Stage IV Hodgkin lymphoma DNR CC Diagnosed in June 2021 Underwent 5-6 cycles of chemotherapy, stopped treatment on his own WBC 2.52 CTPA with nonspecific mediastinal, right hilar, and periportal lymph nodes concerning for metastatic disease Pulmonary consulted during last admission 2 weeks ago as pt declined further therapy for his lymphoma and is not interested in further diagnostic evaluation.   Oncology consulted prior admission - Recommend PET CT scan outpatient if patient desires follow-up. Would need to follow-up back for surveillance and evaluate for recurrent disease. Palliative consulted as above.  CODE STATUS DNR CC