chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea, Emphysema, Fatigue, Full blood count normal, Hypertension
Clinical narrative: Patient is a 63 y.o. male patient of MD with history of severe COPD, chronic respiratory failure on 6 L of oxygen at home, hypertension, anxiety, depression, BPH, cachexia, history of tobacco use presented on 11/9/2023 with shortness of breath. Patient found to be in acute exacerbation of COPD as well as have COVID.   Acute on chronic hypoxic respiratory failure Acute exacerbation of COPD History of severe COPD Patient with history of severe COPD presented with shortness of breath, tested positive with COVID-19 History of chronic respiratory failure on 6 L of oxygen, requiring BiPAP in the ER. Patient on breztri and albuterol inhalers at home  Patient initially admitted to ICU, however was weaned down to 6 L while in the ER and was deemed to be stepdown appropriate where he stayed until discharge  Initial CBC unremarkable, lactic acidosis 2.8, troponin and BNP within normal range Blood cultures 11/9: NGTD In the ER received azithromycin and ceftriaxone CXR with severe bullous emphysema, new hazy and patchy right basilar density suspicious for infiltrate/pneumonia Treated with azithromycin, steroids, and treatment of COVID as below.  Home inhalers, breathing treatments continued at discharge.    Covid-19 Virus Infection Date of onset of symptoms: 2 weeks prior to admission  Symptoms present on admission: Shortness of breath, cough, fatigue, generalized weakness Date of covid positive test: 11/9/23 Vaccination status: vaccinated, no booster Imaging: CXR?severe bullous emphysema.  New hazy and patchy right basilar density suspicious for infiltrate/pneumonia. Oxygen requirements on admission: BIPAP Oxygen requirements on discharge: 6L nasal cannula (baseline) Medical therapy: remdesivir, steroids, azithromycin, tocilizumab  Procal negative  Patient stable on home O2 requirements x48 hours prior to discharge    Hypertension Home carvedilol restarted at time of discharge   Anxiety/Depression Continued citalopram  BPH Continued Flomax    Cachexia In setting of severe COPD BMI 14.2 Dietitian consulted and followed during admission; received Boost BID in addition to meals
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Intensive care, Lactic acidosis, Lung opacity, Positive airway pressure therapy, SARS-CoV-2 test positive
Clinical narrative: Patient is a 63 y.o. male patient of MD with history of severe COPD, chronic respiratory failure on 6 L of oxygen at home, hypertension, anxiety, depression, BPH, cachexia, history of tobacco use presented on 11/9/2023 with shortness of breath. Patient found to be in acute exacerbation of COPD as well as have COVID.   Acute on chronic hypoxic respiratory failure Acute exacerbation of COPD History of severe COPD Patient with history of severe COPD presented with shortness of breath, tested positive with COVID-19 History of chronic respiratory failure on 6 L of oxygen, requiring BiPAP in the ER. Patient on breztri and albuterol inhalers at home  Patient initially admitted to ICU, however was weaned down to 6 L while in the ER and was deemed to be stepdown appropriate where he stayed until discharge  Initial CBC unremarkable, lactic acidosis 2.8, troponin and BNP within normal range Blood cultures 11/9: NGTD In the ER received azithromycin and ceftriaxone CXR with severe bullous emphysema, new hazy and patchy right basilar density suspicious for infiltrate/pneumonia Treated with azithromycin, steroids, and treatment of COVID as below.  Home inhalers, breathing treatments continued at discharge.    Covid-19 Virus Infection Date of onset of symptoms: 2 weeks prior to admission  Symptoms present on admission: Shortness of breath, cough, fatigue, generalized weakness Date of covid positive test: 11/9/23 Vaccination status: vaccinated, no booster Imaging: CXR?severe bullous emphysema.  New hazy and patchy right basilar density suspicious for infiltrate/pneumonia. Oxygen requirements on admission: BIPAP Oxygen requirements on discharge: 6L nasal cannula (baseline) Medical therapy: remdesivir, steroids, azithromycin, tocilizumab  Procal negative  Patient stable on home O2 requirements x48 hours prior to discharge    Hypertension Home carvedilol restarted at time of discharge   Anxiety/Depression Continued citalopram  BPH Continued Flomax    Cachexia In setting of severe COPD BMI 14.2 Dietitian consulted and followed during admission; received Boost BID in addition to meals
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Troponin normal
Clinical narrative: Patient is a 63 y.o. male patient of MD with history of severe COPD, chronic respiratory failure on 6 L of oxygen at home, hypertension, anxiety, depression, BPH, cachexia, history of tobacco use presented on 11/9/2023 with shortness of breath. Patient found to be in acute exacerbation of COPD as well as have COVID.   Acute on chronic hypoxic respiratory failure Acute exacerbation of COPD History of severe COPD Patient with history of severe COPD presented with shortness of breath, tested positive with COVID-19 History of chronic respiratory failure on 6 L of oxygen, requiring BiPAP in the ER. Patient on breztri and albuterol inhalers at home  Patient initially admitted to ICU, however was weaned down to 6 L while in the ER and was deemed to be stepdown appropriate where he stayed until discharge  Initial CBC unremarkable, lactic acidosis 2.8, troponin and BNP within normal range Blood cultures 11/9: NGTD In the ER received azithromycin and ceftriaxone CXR with severe bullous emphysema, new hazy and patchy right basilar density suspicious for infiltrate/pneumonia Treated with azithromycin, steroids, and treatment of COVID as below.  Home inhalers, breathing treatments continued at discharge.    Covid-19 Virus Infection Date of onset of symptoms: 2 weeks prior to admission  Symptoms present on admission: Shortness of breath, cough, fatigue, generalized weakness Date of covid positive test: 11/9/23 Vaccination status: vaccinated, no booster Imaging: CXR?severe bullous emphysema.  New hazy and patchy right basilar density suspicious for infiltrate/pneumonia. Oxygen requirements on admission: BIPAP Oxygen requirements on discharge: 6L nasal cannula (baseline) Medical therapy: remdesivir, steroids, azithromycin, tocilizumab  Procal negative  Patient stable on home O2 requirements x48 hours prior to discharge    Hypertension Home carvedilol restarted at time of discharge   Anxiety/Depression Continued citalopram  BPH Continued Flomax    Cachexia In setting of severe COPD BMI 14.2 Dietitian consulted and followed during admission; received Boost BID in addition to meals
Age: 17.0
Sex: M
Vaccine: MNQ
Symptoms: Abdominal pain upper, Abnormal behaviour, Anti-cyclic citrullinated peptide antibody negative, Antinuclear antibody negative, Arthralgia
Clinical narrative: 12/7/23 - Pediatrician well visit appointment (3:30pm), received Meningococcal ACWY vaccine, all vitals and examination normal 12/8/23 (Evening) - Onset of nightly stomach pain 12/9/23 (Evening) - Worked shift. Complained feet were sore while working. 12/10/23 (Morning) - Upon waking, bilateral 2nd MTP joint pain and swelling. Unable to put weight on feet. 12/11/23 - First missed day of school & work (has not returned since).  12/12/23 - Severe fatigue, brain fog began. Sleeping until 11am and taking afternoon naps - abnormal behaviors for him. 12/14/23 - Walk-in orthopedic clinic - prescribed boot, methylprednisone dose pack, PT, x-rays (bones are good, swelling observed on imaging). Worked for 1 hour, unable to complete shift.  12/15/23 - Started steroid, mental clarity and some energy returned. 12/16/23 - foot pain and swelling improved, but other symptoms became apparent without the severe foot pain, widespread muscle weakness when at rest and bilateral joint fatigue and weakness when moving. Both knees are the weakest and most prominent. Difficult to hold arms up or to get into a comfortable position. 12/17/23 - Bloodwork, went to school for half a day and was extremely fatigued afterwards for 2 days. 12/23/23 - No prednisone since 12/21. Bilateral MTP joint pain and swelling returned. Fatigue, aches, and weakness worse since stopping steroid. All Symptoms Bilateral MTP joint pain without injury or history Stomach pain - nightly Extreme fatigue, malaise. Worse following activity. Brain fog Migrating bilateral joint pain  Weak, aching muscles and joints Body feels heavy Finds relief in water (hot tub) because he feels the weight is lifted Tingling feet upon waking in the morning Covid infection in October - no noticeable long-term effects
Age: 17.0
Sex: M
Vaccine: MNQ
Symptoms: Blood creatine phosphokinase normal, Blood thyroid stimulating hormone normal, Brain fog, C-reactive protein normal, Complement factor C3
Clinical narrative: 12/7/23 - Pediatrician well visit appointment (3:30pm), received Meningococcal ACWY vaccine, all vitals and examination normal 12/8/23 (Evening) - Onset of nightly stomach pain 12/9/23 (Evening) - Worked shift. Complained feet were sore while working. 12/10/23 (Morning) - Upon waking, bilateral 2nd MTP joint pain and swelling. Unable to put weight on feet. 12/11/23 - First missed day of school & work (has not returned since).  12/12/23 - Severe fatigue, brain fog began. Sleeping until 11am and taking afternoon naps - abnormal behaviors for him. 12/14/23 - Walk-in orthopedic clinic - prescribed boot, methylprednisone dose pack, PT, x-rays (bones are good, swelling observed on imaging). Worked for 1 hour, unable to complete shift.  12/15/23 - Started steroid, mental clarity and some energy returned. 12/16/23 - foot pain and swelling improved, but other symptoms became apparent without the severe foot pain, widespread muscle weakness when at rest and bilateral joint fatigue and weakness when moving. Both knees are the weakest and most prominent. Difficult to hold arms up or to get into a comfortable position. 12/17/23 - Bloodwork, went to school for half a day and was extremely fatigued afterwards for 2 days. 12/23/23 - No prednisone since 12/21. Bilateral MTP joint pain and swelling returned. Fatigue, aches, and weakness worse since stopping steroid. All Symptoms Bilateral MTP joint pain without injury or history Stomach pain - nightly Extreme fatigue, malaise. Worse following activity. Brain fog Migrating bilateral joint pain  Weak, aching muscles and joints Body feels heavy Finds relief in water (hot tub) because he feels the weight is lifted Tingling feet upon waking in the morning Covid infection in October - no noticeable long-term effects
Age: 17.0
Sex: M
Vaccine: MNQ
Symptoms: Complement factor C4, Complement factor normal, Discomfort, Fatigue, Full blood count normal
Clinical narrative: 12/7/23 - Pediatrician well visit appointment (3:30pm), received Meningococcal ACWY vaccine, all vitals and examination normal 12/8/23 (Evening) - Onset of nightly stomach pain 12/9/23 (Evening) - Worked shift. Complained feet were sore while working. 12/10/23 (Morning) - Upon waking, bilateral 2nd MTP joint pain and swelling. Unable to put weight on feet. 12/11/23 - First missed day of school & work (has not returned since).  12/12/23 - Severe fatigue, brain fog began. Sleeping until 11am and taking afternoon naps - abnormal behaviors for him. 12/14/23 - Walk-in orthopedic clinic - prescribed boot, methylprednisone dose pack, PT, x-rays (bones are good, swelling observed on imaging). Worked for 1 hour, unable to complete shift.  12/15/23 - Started steroid, mental clarity and some energy returned. 12/16/23 - foot pain and swelling improved, but other symptoms became apparent without the severe foot pain, widespread muscle weakness when at rest and bilateral joint fatigue and weakness when moving. Both knees are the weakest and most prominent. Difficult to hold arms up or to get into a comfortable position. 12/17/23 - Bloodwork, went to school for half a day and was extremely fatigued afterwards for 2 days. 12/23/23 - No prednisone since 12/21. Bilateral MTP joint pain and swelling returned. Fatigue, aches, and weakness worse since stopping steroid. All Symptoms Bilateral MTP joint pain without injury or history Stomach pain - nightly Extreme fatigue, malaise. Worse following activity. Brain fog Migrating bilateral joint pain  Weak, aching muscles and joints Body feels heavy Finds relief in water (hot tub) because he feels the weight is lifted Tingling feet upon waking in the morning Covid infection in October - no noticeable long-term effects
Age: 17.0
Sex: M
Vaccine: MNQ
Symptoms: Glucose-6-phosphate dehydrogenase normal, Hepatitis B core antibody negative, Hepatitis B surface antibody negative, Hepatitis C antibody negative, Hypersomnia
Clinical narrative: 12/7/23 - Pediatrician well visit appointment (3:30pm), received Meningococcal ACWY vaccine, all vitals and examination normal 12/8/23 (Evening) - Onset of nightly stomach pain 12/9/23 (Evening) - Worked shift. Complained feet were sore while working. 12/10/23 (Morning) - Upon waking, bilateral 2nd MTP joint pain and swelling. Unable to put weight on feet. 12/11/23 - First missed day of school & work (has not returned since).  12/12/23 - Severe fatigue, brain fog began. Sleeping until 11am and taking afternoon naps - abnormal behaviors for him. 12/14/23 - Walk-in orthopedic clinic - prescribed boot, methylprednisone dose pack, PT, x-rays (bones are good, swelling observed on imaging). Worked for 1 hour, unable to complete shift.  12/15/23 - Started steroid, mental clarity and some energy returned. 12/16/23 - foot pain and swelling improved, but other symptoms became apparent without the severe foot pain, widespread muscle weakness when at rest and bilateral joint fatigue and weakness when moving. Both knees are the weakest and most prominent. Difficult to hold arms up or to get into a comfortable position. 12/17/23 - Bloodwork, went to school for half a day and was extremely fatigued afterwards for 2 days. 12/23/23 - No prednisone since 12/21. Bilateral MTP joint pain and swelling returned. Fatigue, aches, and weakness worse since stopping steroid. All Symptoms Bilateral MTP joint pain without injury or history Stomach pain - nightly Extreme fatigue, malaise. Worse following activity. Brain fog Migrating bilateral joint pain  Weak, aching muscles and joints Body feels heavy Finds relief in water (hot tub) because he feels the weight is lifted Tingling feet upon waking in the morning Covid infection in October - no noticeable long-term effects
Age: 17.0
Sex: M
Vaccine: MNQ
Symptoms: Impaired work ability, Joint swelling, Lipids normal, Loss of personal independence in daily activities, Malaise
Clinical narrative: 12/7/23 - Pediatrician well visit appointment (3:30pm), received Meningococcal ACWY vaccine, all vitals and examination normal 12/8/23 (Evening) - Onset of nightly stomach pain 12/9/23 (Evening) - Worked shift. Complained feet were sore while working. 12/10/23 (Morning) - Upon waking, bilateral 2nd MTP joint pain and swelling. Unable to put weight on feet. 12/11/23 - First missed day of school & work (has not returned since).  12/12/23 - Severe fatigue, brain fog began. Sleeping until 11am and taking afternoon naps - abnormal behaviors for him. 12/14/23 - Walk-in orthopedic clinic - prescribed boot, methylprednisone dose pack, PT, x-rays (bones are good, swelling observed on imaging). Worked for 1 hour, unable to complete shift.  12/15/23 - Started steroid, mental clarity and some energy returned. 12/16/23 - foot pain and swelling improved, but other symptoms became apparent without the severe foot pain, widespread muscle weakness when at rest and bilateral joint fatigue and weakness when moving. Both knees are the weakest and most prominent. Difficult to hold arms up or to get into a comfortable position. 12/17/23 - Bloodwork, went to school for half a day and was extremely fatigued afterwards for 2 days. 12/23/23 - No prednisone since 12/21. Bilateral MTP joint pain and swelling returned. Fatigue, aches, and weakness worse since stopping steroid. All Symptoms Bilateral MTP joint pain without injury or history Stomach pain - nightly Extreme fatigue, malaise. Worse following activity. Brain fog Migrating bilateral joint pain  Weak, aching muscles and joints Body feels heavy Finds relief in water (hot tub) because he feels the weight is lifted Tingling feet upon waking in the morning Covid infection in October - no noticeable long-term effects
Age: 17.0
Sex: M
Vaccine: MNQ
Symptoms: Metabolic function test normal, Mobility decreased, Muscular weakness, Pain in extremity, Paraesthesia
Clinical narrative: 12/7/23 - Pediatrician well visit appointment (3:30pm), received Meningococcal ACWY vaccine, all vitals and examination normal 12/8/23 (Evening) - Onset of nightly stomach pain 12/9/23 (Evening) - Worked shift. Complained feet were sore while working. 12/10/23 (Morning) - Upon waking, bilateral 2nd MTP joint pain and swelling. Unable to put weight on feet. 12/11/23 - First missed day of school & work (has not returned since).  12/12/23 - Severe fatigue, brain fog began. Sleeping until 11am and taking afternoon naps - abnormal behaviors for him. 12/14/23 - Walk-in orthopedic clinic - prescribed boot, methylprednisone dose pack, PT, x-rays (bones are good, swelling observed on imaging). Worked for 1 hour, unable to complete shift.  12/15/23 - Started steroid, mental clarity and some energy returned. 12/16/23 - foot pain and swelling improved, but other symptoms became apparent without the severe foot pain, widespread muscle weakness when at rest and bilateral joint fatigue and weakness when moving. Both knees are the weakest and most prominent. Difficult to hold arms up or to get into a comfortable position. 12/17/23 - Bloodwork, went to school for half a day and was extremely fatigued afterwards for 2 days. 12/23/23 - No prednisone since 12/21. Bilateral MTP joint pain and swelling returned. Fatigue, aches, and weakness worse since stopping steroid. All Symptoms Bilateral MTP joint pain without injury or history Stomach pain - nightly Extreme fatigue, malaise. Worse following activity. Brain fog Migrating bilateral joint pain  Weak, aching muscles and joints Body feels heavy Finds relief in water (hot tub) because he feels the weight is lifted Tingling feet upon waking in the morning Covid infection in October - no noticeable long-term effects
Age: 17.0
Sex: M
Vaccine: MNQ
Symptoms: Red blood cell sedimentation rate normal, Rheumatoid factor negative, Serum ferritin normal, Spinal X-ray normal, Thyroxine free normal
Clinical narrative: 12/7/23 - Pediatrician well visit appointment (3:30pm), received Meningococcal ACWY vaccine, all vitals and examination normal 12/8/23 (Evening) - Onset of nightly stomach pain 12/9/23 (Evening) - Worked shift. Complained feet were sore while working. 12/10/23 (Morning) - Upon waking, bilateral 2nd MTP joint pain and swelling. Unable to put weight on feet. 12/11/23 - First missed day of school & work (has not returned since).  12/12/23 - Severe fatigue, brain fog began. Sleeping until 11am and taking afternoon naps - abnormal behaviors for him. 12/14/23 - Walk-in orthopedic clinic - prescribed boot, methylprednisone dose pack, PT, x-rays (bones are good, swelling observed on imaging). Worked for 1 hour, unable to complete shift.  12/15/23 - Started steroid, mental clarity and some energy returned. 12/16/23 - foot pain and swelling improved, but other symptoms became apparent without the severe foot pain, widespread muscle weakness when at rest and bilateral joint fatigue and weakness when moving. Both knees are the weakest and most prominent. Difficult to hold arms up or to get into a comfortable position. 12/17/23 - Bloodwork, went to school for half a day and was extremely fatigued afterwards for 2 days. 12/23/23 - No prednisone since 12/21. Bilateral MTP joint pain and swelling returned. Fatigue, aches, and weakness worse since stopping steroid. All Symptoms Bilateral MTP joint pain without injury or history Stomach pain - nightly Extreme fatigue, malaise. Worse following activity. Brain fog Migrating bilateral joint pain  Weak, aching muscles and joints Body feels heavy Finds relief in water (hot tub) because he feels the weight is lifted Tingling feet upon waking in the morning Covid infection in October - no noticeable long-term effects
Age: 17.0
Sex: M
Vaccine: MNQ
Symptoms: Urine analysis normal, Vitamin D decreased, Weight bearing difficulty, X-ray limb abnormal, X-ray limb normal
Clinical narrative: 12/7/23 - Pediatrician well visit appointment (3:30pm), received Meningococcal ACWY vaccine, all vitals and examination normal 12/8/23 (Evening) - Onset of nightly stomach pain 12/9/23 (Evening) - Worked shift. Complained feet were sore while working. 12/10/23 (Morning) - Upon waking, bilateral 2nd MTP joint pain and swelling. Unable to put weight on feet. 12/11/23 - First missed day of school & work (has not returned since).  12/12/23 - Severe fatigue, brain fog began. Sleeping until 11am and taking afternoon naps - abnormal behaviors for him. 12/14/23 - Walk-in orthopedic clinic - prescribed boot, methylprednisone dose pack, PT, x-rays (bones are good, swelling observed on imaging). Worked for 1 hour, unable to complete shift.  12/15/23 - Started steroid, mental clarity and some energy returned. 12/16/23 - foot pain and swelling improved, but other symptoms became apparent without the severe foot pain, widespread muscle weakness when at rest and bilateral joint fatigue and weakness when moving. Both knees are the weakest and most prominent. Difficult to hold arms up or to get into a comfortable position. 12/17/23 - Bloodwork, went to school for half a day and was extremely fatigued afterwards for 2 days. 12/23/23 - No prednisone since 12/21. Bilateral MTP joint pain and swelling returned. Fatigue, aches, and weakness worse since stopping steroid. All Symptoms Bilateral MTP joint pain without injury or history Stomach pain - nightly Extreme fatigue, malaise. Worse following activity. Brain fog Migrating bilateral joint pain  Weak, aching muscles and joints Body feels heavy Finds relief in water (hot tub) because he feels the weight is lifted Tingling feet upon waking in the morning Covid infection in October - no noticeable long-term effects
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Agitation, Anaemia, Anxiety, Atelectasis
Clinical narrative: Assessment and Plan Patient is a 54 y.o. male patient of DO with history of end-stage renal disease, dialysis, diabetes, hypertension, hyperlipidemia, spina bifida presented on 11/5/2023 with AMS and acute respiratory failure. Was seen by palliative care, made a DNR CC and transferred to hospice.   Acute Metabolic Encephalopathy-resolved DDx: Metabolic v. Hypoxia/hypercapnea v. Infxn v. Rx v. Uremia  CTH: No acute brain pathology. Opacification of the nasal airways and sphenoid sinusitis.  Awake, alert and interactive during my exam Transitioned to DNR CC today 11/12 Continue prn morphine for pain Prn ativan for anxiety, prn haldol for agitation  Prn ani-emetics Prn robinul for secretions  Palliative care seeing patient today, await further recommendations    Acute Respiratory Failure with hypoxia COVID-19 Respiratory Acidosis  2/2  V/Q mismatch (PNA) CT PE 11/5: There is no central PE but further distally evaluation is quite limited. Moderate scattered atelectasis. Consolidation at the left lung base  ED started Zosyn and vancomycin ABG shows respiratory acidosis with inability to compensate metabolically secondary to renal failure Patient initially intubated and sedated Requested meeting with family regarding plan, he wishes to be extubated which was done today 11/12-- >patient also transitioned to DNR CC.  Palliative care seeing patient today, await further recommendations    Septic Shock Leukocytosis Secondary to PNA SIRS criteria: febrile, HR >90, RR >20, Leukocytosis Initial Lactic Acid 3.2 MRSA positive Blood cultures 11/5: 4/4 significant for G+ Bacilli  Repeat blood cultures 11/7: NGTD Levophed and abx discontinued due to DNR CC status ESRD Hyperphosphatemia  HD TTS Tunneled HD cath left chest F/w Dr.  Nephrology following, recommend Prisma until pressor requirements decrease Transitioned to DNR CC    Chronic Myocardial Injury Likely secondary to ESRD, possible volume related TTE: EF 70%, RV not well visualized Elevated troponin 114, repeat EKG, repeat troponin showed no signs of acute ischemia Troponin peaked 152, now down trending   Elevated TSH Home med discontinued due to DNR CC status    Anemia Hemoglobin of 9.8, has been stable    History of diabetes mellitus Insulin discontinued  Pt DNR CC    Sacral pressure injury Stage 3  POA    HAGMA-resolved Lactic Acidosis-resolved
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Azotaemia, Bacillus test positive, Blood culture positive, Blood gases abnormal, Blood lactic acid
Clinical narrative: Assessment and Plan Patient is a 54 y.o. male patient of DO with history of end-stage renal disease, dialysis, diabetes, hypertension, hyperlipidemia, spina bifida presented on 11/5/2023 with AMS and acute respiratory failure. Was seen by palliative care, made a DNR CC and transferred to hospice.   Acute Metabolic Encephalopathy-resolved DDx: Metabolic v. Hypoxia/hypercapnea v. Infxn v. Rx v. Uremia  CTH: No acute brain pathology. Opacification of the nasal airways and sphenoid sinusitis.  Awake, alert and interactive during my exam Transitioned to DNR CC today 11/12 Continue prn morphine for pain Prn ativan for anxiety, prn haldol for agitation  Prn ani-emetics Prn robinul for secretions  Palliative care seeing patient today, await further recommendations    Acute Respiratory Failure with hypoxia COVID-19 Respiratory Acidosis  2/2  V/Q mismatch (PNA) CT PE 11/5: There is no central PE but further distally evaluation is quite limited. Moderate scattered atelectasis. Consolidation at the left lung base  ED started Zosyn and vancomycin ABG shows respiratory acidosis with inability to compensate metabolically secondary to renal failure Patient initially intubated and sedated Requested meeting with family regarding plan, he wishes to be extubated which was done today 11/12-- >patient also transitioned to DNR CC.  Palliative care seeing patient today, await further recommendations    Septic Shock Leukocytosis Secondary to PNA SIRS criteria: febrile, HR >90, RR >20, Leukocytosis Initial Lactic Acid 3.2 MRSA positive Blood cultures 11/5: 4/4 significant for G+ Bacilli  Repeat blood cultures 11/7: NGTD Levophed and abx discontinued due to DNR CC status ESRD Hyperphosphatemia  HD TTS Tunneled HD cath left chest F/w Dr.  Nephrology following, recommend Prisma until pressor requirements decrease Transitioned to DNR CC    Chronic Myocardial Injury Likely secondary to ESRD, possible volume related TTE: EF 70%, RV not well visualized Elevated troponin 114, repeat EKG, repeat troponin showed no signs of acute ischemia Troponin peaked 152, now down trending   Elevated TSH Home med discontinued due to DNR CC status    Anemia Hemoglobin of 9.8, has been stable    History of diabetes mellitus Insulin discontinued  Pt DNR CC    Sacral pressure injury Stage 3  POA    HAGMA-resolved Lactic Acidosis-resolved
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Blood thyroid stimulating hormone increased, COVID-19, Central venous catheterisation, Computerised tomogram head abnormal, Computerised tomogram thorax abnormal
Clinical narrative: Assessment and Plan Patient is a 54 y.o. male patient of DO with history of end-stage renal disease, dialysis, diabetes, hypertension, hyperlipidemia, spina bifida presented on 11/5/2023 with AMS and acute respiratory failure. Was seen by palliative care, made a DNR CC and transferred to hospice.   Acute Metabolic Encephalopathy-resolved DDx: Metabolic v. Hypoxia/hypercapnea v. Infxn v. Rx v. Uremia  CTH: No acute brain pathology. Opacification of the nasal airways and sphenoid sinusitis.  Awake, alert and interactive during my exam Transitioned to DNR CC today 11/12 Continue prn morphine for pain Prn ativan for anxiety, prn haldol for agitation  Prn ani-emetics Prn robinul for secretions  Palliative care seeing patient today, await further recommendations    Acute Respiratory Failure with hypoxia COVID-19 Respiratory Acidosis  2/2  V/Q mismatch (PNA) CT PE 11/5: There is no central PE but further distally evaluation is quite limited. Moderate scattered atelectasis. Consolidation at the left lung base  ED started Zosyn and vancomycin ABG shows respiratory acidosis with inability to compensate metabolically secondary to renal failure Patient initially intubated and sedated Requested meeting with family regarding plan, he wishes to be extubated which was done today 11/12-- >patient also transitioned to DNR CC.  Palliative care seeing patient today, await further recommendations    Septic Shock Leukocytosis Secondary to PNA SIRS criteria: febrile, HR >90, RR >20, Leukocytosis Initial Lactic Acid 3.2 MRSA positive Blood cultures 11/5: 4/4 significant for G+ Bacilli  Repeat blood cultures 11/7: NGTD Levophed and abx discontinued due to DNR CC status ESRD Hyperphosphatemia  HD TTS Tunneled HD cath left chest F/w Dr.  Nephrology following, recommend Prisma until pressor requirements decrease Transitioned to DNR CC    Chronic Myocardial Injury Likely secondary to ESRD, possible volume related TTE: EF 70%, RV not well visualized Elevated troponin 114, repeat EKG, repeat troponin showed no signs of acute ischemia Troponin peaked 152, now down trending   Elevated TSH Home med discontinued due to DNR CC status    Anemia Hemoglobin of 9.8, has been stable    History of diabetes mellitus Insulin discontinued  Pt DNR CC    Sacral pressure injury Stage 3  POA    HAGMA-resolved Lactic Acidosis-resolved
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Condition aggravated, Decubitus ulcer, Echocardiogram, Ejection fraction normal, Electrocardiogram normal
Clinical narrative: Assessment and Plan Patient is a 54 y.o. male patient of DO with history of end-stage renal disease, dialysis, diabetes, hypertension, hyperlipidemia, spina bifida presented on 11/5/2023 with AMS and acute respiratory failure. Was seen by palliative care, made a DNR CC and transferred to hospice.   Acute Metabolic Encephalopathy-resolved DDx: Metabolic v. Hypoxia/hypercapnea v. Infxn v. Rx v. Uremia  CTH: No acute brain pathology. Opacification of the nasal airways and sphenoid sinusitis.  Awake, alert and interactive during my exam Transitioned to DNR CC today 11/12 Continue prn morphine for pain Prn ativan for anxiety, prn haldol for agitation  Prn ani-emetics Prn robinul for secretions  Palliative care seeing patient today, await further recommendations    Acute Respiratory Failure with hypoxia COVID-19 Respiratory Acidosis  2/2  V/Q mismatch (PNA) CT PE 11/5: There is no central PE but further distally evaluation is quite limited. Moderate scattered atelectasis. Consolidation at the left lung base  ED started Zosyn and vancomycin ABG shows respiratory acidosis with inability to compensate metabolically secondary to renal failure Patient initially intubated and sedated Requested meeting with family regarding plan, he wishes to be extubated which was done today 11/12-- >patient also transitioned to DNR CC.  Palliative care seeing patient today, await further recommendations    Septic Shock Leukocytosis Secondary to PNA SIRS criteria: febrile, HR >90, RR >20, Leukocytosis Initial Lactic Acid 3.2 MRSA positive Blood cultures 11/5: 4/4 significant for G+ Bacilli  Repeat blood cultures 11/7: NGTD Levophed and abx discontinued due to DNR CC status ESRD Hyperphosphatemia  HD TTS Tunneled HD cath left chest F/w Dr.  Nephrology following, recommend Prisma until pressor requirements decrease Transitioned to DNR CC    Chronic Myocardial Injury Likely secondary to ESRD, possible volume related TTE: EF 70%, RV not well visualized Elevated troponin 114, repeat EKG, repeat troponin showed no signs of acute ischemia Troponin peaked 152, now down trending   Elevated TSH Home med discontinued due to DNR CC status    Anemia Hemoglobin of 9.8, has been stable    History of diabetes mellitus Insulin discontinued  Pt DNR CC    Sacral pressure injury Stage 3  POA    HAGMA-resolved Lactic Acidosis-resolved
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: End stage renal disease, Endotracheal intubation, Haemodialysis, Haemoglobin decreased, Hypercapnia
Clinical narrative: Assessment and Plan Patient is a 54 y.o. male patient of DO with history of end-stage renal disease, dialysis, diabetes, hypertension, hyperlipidemia, spina bifida presented on 11/5/2023 with AMS and acute respiratory failure. Was seen by palliative care, made a DNR CC and transferred to hospice.   Acute Metabolic Encephalopathy-resolved DDx: Metabolic v. Hypoxia/hypercapnea v. Infxn v. Rx v. Uremia  CTH: No acute brain pathology. Opacification of the nasal airways and sphenoid sinusitis.  Awake, alert and interactive during my exam Transitioned to DNR CC today 11/12 Continue prn morphine for pain Prn ativan for anxiety, prn haldol for agitation  Prn ani-emetics Prn robinul for secretions  Palliative care seeing patient today, await further recommendations    Acute Respiratory Failure with hypoxia COVID-19 Respiratory Acidosis  2/2  V/Q mismatch (PNA) CT PE 11/5: There is no central PE but further distally evaluation is quite limited. Moderate scattered atelectasis. Consolidation at the left lung base  ED started Zosyn and vancomycin ABG shows respiratory acidosis with inability to compensate metabolically secondary to renal failure Patient initially intubated and sedated Requested meeting with family regarding plan, he wishes to be extubated which was done today 11/12-- >patient also transitioned to DNR CC.  Palliative care seeing patient today, await further recommendations    Septic Shock Leukocytosis Secondary to PNA SIRS criteria: febrile, HR >90, RR >20, Leukocytosis Initial Lactic Acid 3.2 MRSA positive Blood cultures 11/5: 4/4 significant for G+ Bacilli  Repeat blood cultures 11/7: NGTD Levophed and abx discontinued due to DNR CC status ESRD Hyperphosphatemia  HD TTS Tunneled HD cath left chest F/w Dr.  Nephrology following, recommend Prisma until pressor requirements decrease Transitioned to DNR CC    Chronic Myocardial Injury Likely secondary to ESRD, possible volume related TTE: EF 70%, RV not well visualized Elevated troponin 114, repeat EKG, repeat troponin showed no signs of acute ischemia Troponin peaked 152, now down trending   Elevated TSH Home med discontinued due to DNR CC status    Anemia Hemoglobin of 9.8, has been stable    History of diabetes mellitus Insulin discontinued  Pt DNR CC    Sacral pressure injury Stage 3  POA    HAGMA-resolved Lactic Acidosis-resolved
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Hyperphosphataemia, Hypoxia, Infection, Lactic acidosis, Leukocytosis
Clinical narrative: Assessment and Plan Patient is a 54 y.o. male patient of DO with history of end-stage renal disease, dialysis, diabetes, hypertension, hyperlipidemia, spina bifida presented on 11/5/2023 with AMS and acute respiratory failure. Was seen by palliative care, made a DNR CC and transferred to hospice.   Acute Metabolic Encephalopathy-resolved DDx: Metabolic v. Hypoxia/hypercapnea v. Infxn v. Rx v. Uremia  CTH: No acute brain pathology. Opacification of the nasal airways and sphenoid sinusitis.  Awake, alert and interactive during my exam Transitioned to DNR CC today 11/12 Continue prn morphine for pain Prn ativan for anxiety, prn haldol for agitation  Prn ani-emetics Prn robinul for secretions  Palliative care seeing patient today, await further recommendations    Acute Respiratory Failure with hypoxia COVID-19 Respiratory Acidosis  2/2  V/Q mismatch (PNA) CT PE 11/5: There is no central PE but further distally evaluation is quite limited. Moderate scattered atelectasis. Consolidation at the left lung base  ED started Zosyn and vancomycin ABG shows respiratory acidosis with inability to compensate metabolically secondary to renal failure Patient initially intubated and sedated Requested meeting with family regarding plan, he wishes to be extubated which was done today 11/12-- >patient also transitioned to DNR CC.  Palliative care seeing patient today, await further recommendations    Septic Shock Leukocytosis Secondary to PNA SIRS criteria: febrile, HR >90, RR >20, Leukocytosis Initial Lactic Acid 3.2 MRSA positive Blood cultures 11/5: 4/4 significant for G+ Bacilli  Repeat blood cultures 11/7: NGTD Levophed and abx discontinued due to DNR CC status ESRD Hyperphosphatemia  HD TTS Tunneled HD cath left chest F/w Dr.  Nephrology following, recommend Prisma until pressor requirements decrease Transitioned to DNR CC    Chronic Myocardial Injury Likely secondary to ESRD, possible volume related TTE: EF 70%, RV not well visualized Elevated troponin 114, repeat EKG, repeat troponin showed no signs of acute ischemia Troponin peaked 152, now down trending   Elevated TSH Home med discontinued due to DNR CC status    Anemia Hemoglobin of 9.8, has been stable    History of diabetes mellitus Insulin discontinued  Pt DNR CC    Sacral pressure injury Stage 3  POA    HAGMA-resolved Lactic Acidosis-resolved
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Lung consolidation, Mental status changes, Metabolic acidosis, Metabolic disorder, Metabolic encephalopathy
Clinical narrative: Assessment and Plan Patient is a 54 y.o. male patient of DO with history of end-stage renal disease, dialysis, diabetes, hypertension, hyperlipidemia, spina bifida presented on 11/5/2023 with AMS and acute respiratory failure. Was seen by palliative care, made a DNR CC and transferred to hospice.   Acute Metabolic Encephalopathy-resolved DDx: Metabolic v. Hypoxia/hypercapnea v. Infxn v. Rx v. Uremia  CTH: No acute brain pathology. Opacification of the nasal airways and sphenoid sinusitis.  Awake, alert and interactive during my exam Transitioned to DNR CC today 11/12 Continue prn morphine for pain Prn ativan for anxiety, prn haldol for agitation  Prn ani-emetics Prn robinul for secretions  Palliative care seeing patient today, await further recommendations    Acute Respiratory Failure with hypoxia COVID-19 Respiratory Acidosis  2/2  V/Q mismatch (PNA) CT PE 11/5: There is no central PE but further distally evaluation is quite limited. Moderate scattered atelectasis. Consolidation at the left lung base  ED started Zosyn and vancomycin ABG shows respiratory acidosis with inability to compensate metabolically secondary to renal failure Patient initially intubated and sedated Requested meeting with family regarding plan, he wishes to be extubated which was done today 11/12-- >patient also transitioned to DNR CC.  Palliative care seeing patient today, await further recommendations    Septic Shock Leukocytosis Secondary to PNA SIRS criteria: febrile, HR >90, RR >20, Leukocytosis Initial Lactic Acid 3.2 MRSA positive Blood cultures 11/5: 4/4 significant for G+ Bacilli  Repeat blood cultures 11/7: NGTD Levophed and abx discontinued due to DNR CC status ESRD Hyperphosphatemia  HD TTS Tunneled HD cath left chest F/w Dr.  Nephrology following, recommend Prisma until pressor requirements decrease Transitioned to DNR CC    Chronic Myocardial Injury Likely secondary to ESRD, possible volume related TTE: EF 70%, RV not well visualized Elevated troponin 114, repeat EKG, repeat troponin showed no signs of acute ischemia Troponin peaked 152, now down trending   Elevated TSH Home med discontinued due to DNR CC status    Anemia Hemoglobin of 9.8, has been stable    History of diabetes mellitus Insulin discontinued  Pt DNR CC    Sacral pressure injury Stage 3  POA    HAGMA-resolved Lactic Acidosis-resolved
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Myocardial injury, Pain, Pneumonia, Pyrexia, Renal failure
Clinical narrative: Assessment and Plan Patient is a 54 y.o. male patient of DO with history of end-stage renal disease, dialysis, diabetes, hypertension, hyperlipidemia, spina bifida presented on 11/5/2023 with AMS and acute respiratory failure. Was seen by palliative care, made a DNR CC and transferred to hospice.   Acute Metabolic Encephalopathy-resolved DDx: Metabolic v. Hypoxia/hypercapnea v. Infxn v. Rx v. Uremia  CTH: No acute brain pathology. Opacification of the nasal airways and sphenoid sinusitis.  Awake, alert and interactive during my exam Transitioned to DNR CC today 11/12 Continue prn morphine for pain Prn ativan for anxiety, prn haldol for agitation  Prn ani-emetics Prn robinul for secretions  Palliative care seeing patient today, await further recommendations    Acute Respiratory Failure with hypoxia COVID-19 Respiratory Acidosis  2/2  V/Q mismatch (PNA) CT PE 11/5: There is no central PE but further distally evaluation is quite limited. Moderate scattered atelectasis. Consolidation at the left lung base  ED started Zosyn and vancomycin ABG shows respiratory acidosis with inability to compensate metabolically secondary to renal failure Patient initially intubated and sedated Requested meeting with family regarding plan, he wishes to be extubated which was done today 11/12-- >patient also transitioned to DNR CC.  Palliative care seeing patient today, await further recommendations    Septic Shock Leukocytosis Secondary to PNA SIRS criteria: febrile, HR >90, RR >20, Leukocytosis Initial Lactic Acid 3.2 MRSA positive Blood cultures 11/5: 4/4 significant for G+ Bacilli  Repeat blood cultures 11/7: NGTD Levophed and abx discontinued due to DNR CC status ESRD Hyperphosphatemia  HD TTS Tunneled HD cath left chest F/w Dr.  Nephrology following, recommend Prisma until pressor requirements decrease Transitioned to DNR CC    Chronic Myocardial Injury Likely secondary to ESRD, possible volume related TTE: EF 70%, RV not well visualized Elevated troponin 114, repeat EKG, repeat troponin showed no signs of acute ischemia Troponin peaked 152, now down trending   Elevated TSH Home med discontinued due to DNR CC status    Anemia Hemoglobin of 9.8, has been stable    History of diabetes mellitus Insulin discontinued  Pt DNR CC    Sacral pressure injury Stage 3  POA    HAGMA-resolved Lactic Acidosis-resolved
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Respiratory acidosis, Secretion discharge, Septic shock, Sinusitis, Staphylococcus test positive
Clinical narrative: Assessment and Plan Patient is a 54 y.o. male patient of DO with history of end-stage renal disease, dialysis, diabetes, hypertension, hyperlipidemia, spina bifida presented on 11/5/2023 with AMS and acute respiratory failure. Was seen by palliative care, made a DNR CC and transferred to hospice.   Acute Metabolic Encephalopathy-resolved DDx: Metabolic v. Hypoxia/hypercapnea v. Infxn v. Rx v. Uremia  CTH: No acute brain pathology. Opacification of the nasal airways and sphenoid sinusitis.  Awake, alert and interactive during my exam Transitioned to DNR CC today 11/12 Continue prn morphine for pain Prn ativan for anxiety, prn haldol for agitation  Prn ani-emetics Prn robinul for secretions  Palliative care seeing patient today, await further recommendations    Acute Respiratory Failure with hypoxia COVID-19 Respiratory Acidosis  2/2  V/Q mismatch (PNA) CT PE 11/5: There is no central PE but further distally evaluation is quite limited. Moderate scattered atelectasis. Consolidation at the left lung base  ED started Zosyn and vancomycin ABG shows respiratory acidosis with inability to compensate metabolically secondary to renal failure Patient initially intubated and sedated Requested meeting with family regarding plan, he wishes to be extubated which was done today 11/12-- >patient also transitioned to DNR CC.  Palliative care seeing patient today, await further recommendations    Septic Shock Leukocytosis Secondary to PNA SIRS criteria: febrile, HR >90, RR >20, Leukocytosis Initial Lactic Acid 3.2 MRSA positive Blood cultures 11/5: 4/4 significant for G+ Bacilli  Repeat blood cultures 11/7: NGTD Levophed and abx discontinued due to DNR CC status ESRD Hyperphosphatemia  HD TTS Tunneled HD cath left chest F/w Dr.  Nephrology following, recommend Prisma until pressor requirements decrease Transitioned to DNR CC    Chronic Myocardial Injury Likely secondary to ESRD, possible volume related TTE: EF 70%, RV not well visualized Elevated troponin 114, repeat EKG, repeat troponin showed no signs of acute ischemia Troponin peaked 152, now down trending   Elevated TSH Home med discontinued due to DNR CC status    Anemia Hemoglobin of 9.8, has been stable    History of diabetes mellitus Insulin discontinued  Pt DNR CC    Sacral pressure injury Stage 3  POA    HAGMA-resolved Lactic Acidosis-resolved
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Systemic inflammatory response syndrome, Troponin increased, Ventilation/perfusion scan abnormal
Clinical narrative: Assessment and Plan Patient is a 54 y.o. male patient of DO with history of end-stage renal disease, dialysis, diabetes, hypertension, hyperlipidemia, spina bifida presented on 11/5/2023 with AMS and acute respiratory failure. Was seen by palliative care, made a DNR CC and transferred to hospice.   Acute Metabolic Encephalopathy-resolved DDx: Metabolic v. Hypoxia/hypercapnea v. Infxn v. Rx v. Uremia  CTH: No acute brain pathology. Opacification of the nasal airways and sphenoid sinusitis.  Awake, alert and interactive during my exam Transitioned to DNR CC today 11/12 Continue prn morphine for pain Prn ativan for anxiety, prn haldol for agitation  Prn ani-emetics Prn robinul for secretions  Palliative care seeing patient today, await further recommendations    Acute Respiratory Failure with hypoxia COVID-19 Respiratory Acidosis  2/2  V/Q mismatch (PNA) CT PE 11/5: There is no central PE but further distally evaluation is quite limited. Moderate scattered atelectasis. Consolidation at the left lung base  ED started Zosyn and vancomycin ABG shows respiratory acidosis with inability to compensate metabolically secondary to renal failure Patient initially intubated and sedated Requested meeting with family regarding plan, he wishes to be extubated which was done today 11/12-- >patient also transitioned to DNR CC.  Palliative care seeing patient today, await further recommendations    Septic Shock Leukocytosis Secondary to PNA SIRS criteria: febrile, HR >90, RR >20, Leukocytosis Initial Lactic Acid 3.2 MRSA positive Blood cultures 11/5: 4/4 significant for G+ Bacilli  Repeat blood cultures 11/7: NGTD Levophed and abx discontinued due to DNR CC status ESRD Hyperphosphatemia  HD TTS Tunneled HD cath left chest F/w Dr.  Nephrology following, recommend Prisma until pressor requirements decrease Transitioned to DNR CC    Chronic Myocardial Injury Likely secondary to ESRD, possible volume related TTE: EF 70%, RV not well visualized Elevated troponin 114, repeat EKG, repeat troponin showed no signs of acute ischemia Troponin peaked 152, now down trending   Elevated TSH Home med discontinued due to DNR CC status    Anemia Hemoglobin of 9.8, has been stable    History of diabetes mellitus Insulin discontinued  Pt DNR CC    Sacral pressure injury Stage 3  POA    HAGMA-resolved Lactic Acidosis-resolved
Age: 12.0
Sex: M
Vaccine: DTAP
Symptoms: Product administered to patient of inappropriate age, Wrong product administered
Clinical narrative: Patient should have been given a tDap vaccine
Age: 85.0
Sex: M
Vaccine: FLU4, RSV
Symptoms: Death, Encephalitis, Herpes ophthalmic, Herpes zoster, Meningitis
Clinical narrative: Two days after receiving these two vaccines, Patient developed symptoms of shingles in his eye.  By September 22nd, he had developed meningitis/encephalitis that led to a host of other complications that ultimately led to his death.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Anticoagulation drug level above therapeutic, COVID-19, Condition aggravated, Diuretic therapy
Clinical narrative: Patient is a 69 y.o. female with a past medical history significant for HFrEF, CKD, CAD, DVT, GERD, HLD, HTN, hythyroidism, MVR, PAD s/p AKA, afib on coumadin, and T2DM who presented to RMH 11/10/2023 after transfer from ED for shortness of breath. She was found to be hypoxic requiring supplemental O2. COVID-19 was positive on admission. Additionally she appeared fluid overloaded and had a NT-pro BNP of 35k on admission. She was started on IV diuresis for presumed HFrEF exacerbation and declined steroid treatment for COVID infection. Her hospital stay was complicated by supra-therapeutic INR and her home coumadin was held. She developed an AKI on CKD that stabilized with titration of her diuretic therapy. Her oxygen requirement improved and she is stable to discharge home with close follow up and increased dose of torsemide.