chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Confusional state, Cough, Echocardiogram normal, Ejection fraction normal, Electrocardiogram abnormal
Clinical narrative: Patient is a 87 y.o. male who presented from home on 3/4/2023 after a fall.  He was found to have COVID-19 infection.  Was hypoxemic, initially requiring 5 L of oxygen.  Treated with remdesivir and Decadron.  Oxygen weaned off.  All symptoms of COVID have resolved.  Discharged home.        Assessment and Plan Pneumonia due to COVID-19 -Presented with: cough, sore throat, generalized weakness, confusion -His symptoms started on 3/2/2023 with -He tested positive for COVID-19 on admission on 3/4/2023 -He has been vaccinated and boosted x2 -Initially needed to be placed on 5 L oxygen and then slowly weaned off oxygen.  He has been off oxygen since 3/6 -He was treated with Decadron and remdesivir while in the hospital.  Since he has been off oxygen and doing well, medication stopped on discharge   Acute hypoxemic respiratory failure  -Suspect more related to covid -Initially required 5L NC to maintain sats above 90%, now weaned off oxygen -CXR show moderate bilateral lower lung linear opacities of unclear etiology.     Fall Generalized Weakness -no head trauma or LOC -diffusely weak, likely from above -Seen by PT/OT.  Rehab was recommended but patient wanted to go home.  He refused home health since he says he has helpers who comes every day at home to help.   Arrhythmia -Suspect exac by pneumonia (initial ekg show ?"aflutter", repeat ekg show "sinus rhythm w/PAC's" -He was monitored on telemetry metric which showed PACs.  No evidence of A-fib -EKG repeated again on 3/6 with sinus rhythm and PACs -Has history of SVT status post ablation 1997 -Echo with normal EF -Continue beta-blocker    BPH Urinary retention -BPH noted on outpatient chart review, not on medications -Initially needed placement of Foley catheter which was removed.  Voiding well Hematuria -Suspect due to traumatic foley placement in ER -Now resolved
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Fall, Haematuria, Hypoxia, Injury, Lung opacity
Clinical narrative: Patient is a 87 y.o. male who presented from home on 3/4/2023 after a fall.  He was found to have COVID-19 infection.  Was hypoxemic, initially requiring 5 L of oxygen.  Treated with remdesivir and Decadron.  Oxygen weaned off.  All symptoms of COVID have resolved.  Discharged home.        Assessment and Plan Pneumonia due to COVID-19 -Presented with: cough, sore throat, generalized weakness, confusion -His symptoms started on 3/2/2023 with -He tested positive for COVID-19 on admission on 3/4/2023 -He has been vaccinated and boosted x2 -Initially needed to be placed on 5 L oxygen and then slowly weaned off oxygen.  He has been off oxygen since 3/6 -He was treated with Decadron and remdesivir while in the hospital.  Since he has been off oxygen and doing well, medication stopped on discharge   Acute hypoxemic respiratory failure  -Suspect more related to covid -Initially required 5L NC to maintain sats above 90%, now weaned off oxygen -CXR show moderate bilateral lower lung linear opacities of unclear etiology.     Fall Generalized Weakness -no head trauma or LOC -diffusely weak, likely from above -Seen by PT/OT.  Rehab was recommended but patient wanted to go home.  He refused home health since he says he has helpers who comes every day at home to help.   Arrhythmia -Suspect exac by pneumonia (initial ekg show ?"aflutter", repeat ekg show "sinus rhythm w/PAC's" -He was monitored on telemetry metric which showed PACs.  No evidence of A-fib -EKG repeated again on 3/6 with sinus rhythm and PACs -Has history of SVT status post ablation 1997 -Echo with normal EF -Continue beta-blocker    BPH Urinary retention -BPH noted on outpatient chart review, not on medications -Initially needed placement of Foley catheter which was removed.  Voiding well Hematuria -Suspect due to traumatic foley placement in ER -Now resolved
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Malaise, Oropharyngeal pain, SARS-CoV-2 test positive, Sinus rhythm, Supraventricular extrasystoles
Clinical narrative: Patient is a 87 y.o. male who presented from home on 3/4/2023 after a fall.  He was found to have COVID-19 infection.  Was hypoxemic, initially requiring 5 L of oxygen.  Treated with remdesivir and Decadron.  Oxygen weaned off.  All symptoms of COVID have resolved.  Discharged home.        Assessment and Plan Pneumonia due to COVID-19 -Presented with: cough, sore throat, generalized weakness, confusion -His symptoms started on 3/2/2023 with -He tested positive for COVID-19 on admission on 3/4/2023 -He has been vaccinated and boosted x2 -Initially needed to be placed on 5 L oxygen and then slowly weaned off oxygen.  He has been off oxygen since 3/6 -He was treated with Decadron and remdesivir while in the hospital.  Since he has been off oxygen and doing well, medication stopped on discharge   Acute hypoxemic respiratory failure  -Suspect more related to covid -Initially required 5L NC to maintain sats above 90%, now weaned off oxygen -CXR show moderate bilateral lower lung linear opacities of unclear etiology.     Fall Generalized Weakness -no head trauma or LOC -diffusely weak, likely from above -Seen by PT/OT.  Rehab was recommended but patient wanted to go home.  He refused home health since he says he has helpers who comes every day at home to help.   Arrhythmia -Suspect exac by pneumonia (initial ekg show ?"aflutter", repeat ekg show "sinus rhythm w/PAC's" -He was monitored on telemetry metric which showed PACs.  No evidence of A-fib -EKG repeated again on 3/6 with sinus rhythm and PACs -Has history of SVT status post ablation 1997 -Echo with normal EF -Continue beta-blocker    BPH Urinary retention -BPH noted on outpatient chart review, not on medications -Initially needed placement of Foley catheter which was removed.  Voiding well Hematuria -Suspect due to traumatic foley placement in ER -Now resolved
Age: 45.0
Sex: F
Vaccine: VARZOS
Symptoms: Arthralgia, Back pain, Diarrhoea, Neck pain, Pain
Clinical narrative: Patient stated symptoms started late around 10 or 11pm on 03/30/23.  Patient described symptoms as pain in hip, knees, feet, back, hands and neck.  Patient described symptoms as really bad joint pain, body aches, fever and diarrhea.  Patient stated called PCP on 03/31 who instructed her to take Ibuprofen 800 mg and Extra Strength Tylenol. I informed the patient to alternate the medications. Patient denied signs and symptoms of anaphylaxis.  Patient stated she didn't feel well after first dose of Shingrix.
Age: 45.0
Sex: F
Vaccine: VARZOS
Symptoms: Pain in extremity, Pyrexia
Clinical narrative: Patient stated symptoms started late around 10 or 11pm on 03/30/23.  Patient described symptoms as pain in hip, knees, feet, back, hands and neck.  Patient described symptoms as really bad joint pain, body aches, fever and diarrhea.  Patient stated called PCP on 03/31 who instructed her to take Ibuprofen 800 mg and Extra Strength Tylenol. I informed the patient to alternate the medications. Patient denied signs and symptoms of anaphylaxis.  Patient stated she didn't feel well after first dose of Shingrix.
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Asthma, Bipolar disorder, COVID-19, COVID-19 pneumonia
Clinical narrative: The patient is a 45 y.o. female patient.   Patient presented to emergency room for evaluation of shortness of breath, cough, wheezing.  Symptoms have been ongoing for the past day.  Patient reporting feeling diffuse myalgias.  Patient denies any chest pain, fevers, chills.  On admission, patient found to be COVID-positive.  Patient with hypoxia.  CT chest showed pneumonia.  Patient treated with Decadron and remdesivir.  Hypoxia resolved during stay.  Patient discharged home in stable condition instructed follow-up with primary care provider within a week of discharge.   Discharge Diagnoses:   #1 COVID-pneumonia  2.  Acute hypoxic respiratory failure  3.  Hypertension  4.  Bipolar disorder, asthma, COPD history, depression history, GERD, hyperlipidemia, morbid obesity, OSA
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Chronic obstructive pulmonary disease, Computerised tomogram thorax abnormal, Cough, Dyspnoea, Hypertension
Clinical narrative: The patient is a 45 y.o. female patient.   Patient presented to emergency room for evaluation of shortness of breath, cough, wheezing.  Symptoms have been ongoing for the past day.  Patient reporting feeling diffuse myalgias.  Patient denies any chest pain, fevers, chills.  On admission, patient found to be COVID-positive.  Patient with hypoxia.  CT chest showed pneumonia.  Patient treated with Decadron and remdesivir.  Hypoxia resolved during stay.  Patient discharged home in stable condition instructed follow-up with primary care provider within a week of discharge.   Discharge Diagnoses:   #1 COVID-pneumonia  2.  Acute hypoxic respiratory failure  3.  Hypertension  4.  Bipolar disorder, asthma, COPD history, depression history, GERD, hyperlipidemia, morbid obesity, OSA
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Hypoxia, Myalgia, SARS-CoV-2 test positive, Wheezing
Clinical narrative: The patient is a 45 y.o. female patient.   Patient presented to emergency room for evaluation of shortness of breath, cough, wheezing.  Symptoms have been ongoing for the past day.  Patient reporting feeling diffuse myalgias.  Patient denies any chest pain, fevers, chills.  On admission, patient found to be COVID-positive.  Patient with hypoxia.  CT chest showed pneumonia.  Patient treated with Decadron and remdesivir.  Hypoxia resolved during stay.  Patient discharged home in stable condition instructed follow-up with primary care provider within a week of discharge.   Discharge Diagnoses:   #1 COVID-pneumonia  2.  Acute hypoxic respiratory failure  3.  Hypertension  4.  Bipolar disorder, asthma, COPD history, depression history, GERD, hyperlipidemia, morbid obesity, OSA
Age: 72.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, Fatigue, Oropharyngeal pain, SARS-CoV-2 test positive
Clinical narrative: I only had a sore throat and fatigue. I went to the urgent care and they tested me for COVID-19 and it came back positive. They prescribed me BROMFED and another medication.
Age: 11.0
Sex: M
Vaccine: COVID19
Symptoms: Incorrect product formulation administered, No adverse event
Clinical narrative: Mother brought patient into clinic to receive second dose of Pfizer. The only one we had in our EHR was from January 26 making todays dose a second monovalent. After administering The vaccine Mother presented me with another Covid immunization card that had 2 dates listed from 2021 of which those vaccines were given at pharmacy. I informed Dr. she said to submit a VARES and inform Mother that another possible vaccines was to be given in a couple Months as a Bivalent Dose. No adverse reactions or problems were noted.
Age: 95.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, C-reactive protein increased, COVID-19, COVID-19 pneumonia
Clinical narrative: Patient is a 95 y.o. male who presented from  independent living  on 3/2/2023 with hypoxia, and he was found to have COVID-pneumonia.  Since patient required oxygen, patient was treated with Decadron and remdesivir.  Patient's symptoms improved.  Patient still requires oxygen, therefore, he will be discharged with 2 L nasal cannula.  Patient completed remdesivir 5 days treatment in the hospital.  Patiently discharged with Decadron to complete a 10-day treatment.        Assessment and Plan   COVID pneumonia - Presented with: cough, sob, hypoxia  - Symptom onset: 2/28 - Positive COVID-19: 3/2/23 at ED  - Vaccination status: Vaccinated and boosted X 5.  He also had COVID in 12/2022  - CTPE on admission showed multilobar pneumonia  - Oxygen status: Patient be discharged with 2L nasal cannula O2 - Decadron: Patient be discharged with Decadron to complete 10-day course - Remdesivir: Completed 5-day course in the hospital - Serial COVID labs ordered: yes.  CRP improved (from 104.5 down to 55.6).   Acute hypoxic respiratory failure  -Secondary to above  - CTPA negative for PE but did show multilobar pneumonia  -Patiently discharged with home O2   Recurrent UTI  - pt with recurrent UTI's despite suppressive antibiotics -Urine culture positive for Enterococcus -Patient has been treated with ampicillin while in the hospital.  He will be discharged with Macrobid x7 days.   Common variable immunodeficiency -Follows with Dr. of allergy and immunology -Undergoes IgG infusion every 28 days at home with home health Constipation  Possible history of microscopic colitis - history of c diff, now with constipation  - CTPA shows large stool burden - Constipation has resolved -Continue with MiraLAX and senna twice daily -Daughter will continue to wean entocort as an outpatient    Essential HTN -Continue amlodipine    Dementia -No history of agitation -Not on medications   Chronic thrombocytopenia -Stable   Chronic venous insufficiency with BLE edema -Continue with compression hose
Age: 95.0
Sex: M
Vaccine: COVID19-2
Symptoms: Compression garment application, Computerised tomogram thorax abnormal, Constipation, Cough, Culture urine positive
Clinical narrative: Patient is a 95 y.o. male who presented from  independent living  on 3/2/2023 with hypoxia, and he was found to have COVID-pneumonia.  Since patient required oxygen, patient was treated with Decadron and remdesivir.  Patient's symptoms improved.  Patient still requires oxygen, therefore, he will be discharged with 2 L nasal cannula.  Patient completed remdesivir 5 days treatment in the hospital.  Patiently discharged with Decadron to complete a 10-day treatment.        Assessment and Plan   COVID pneumonia - Presented with: cough, sob, hypoxia  - Symptom onset: 2/28 - Positive COVID-19: 3/2/23 at ED  - Vaccination status: Vaccinated and boosted X 5.  He also had COVID in 12/2022  - CTPE on admission showed multilobar pneumonia  - Oxygen status: Patient be discharged with 2L nasal cannula O2 - Decadron: Patient be discharged with Decadron to complete 10-day course - Remdesivir: Completed 5-day course in the hospital - Serial COVID labs ordered: yes.  CRP improved (from 104.5 down to 55.6).   Acute hypoxic respiratory failure  -Secondary to above  - CTPA negative for PE but did show multilobar pneumonia  -Patiently discharged with home O2   Recurrent UTI  - pt with recurrent UTI's despite suppressive antibiotics -Urine culture positive for Enterococcus -Patient has been treated with ampicillin while in the hospital.  He will be discharged with Macrobid x7 days.   Common variable immunodeficiency -Follows with Dr. of allergy and immunology -Undergoes IgG infusion every 28 days at home with home health Constipation  Possible history of microscopic colitis - history of c diff, now with constipation  - CTPA shows large stool burden - Constipation has resolved -Continue with MiraLAX and senna twice daily -Daughter will continue to wean entocort as an outpatient    Essential HTN -Continue amlodipine    Dementia -No history of agitation -Not on medications   Chronic thrombocytopenia -Stable   Chronic venous insufficiency with BLE edema -Continue with compression hose
Age: 95.0
Sex: M
Vaccine: COVID19-2
Symptoms: Dyspnoea, Enterococcus test positive, Faecaloma, Hypoxia, Oedema peripheral
Clinical narrative: Patient is a 95 y.o. male who presented from  independent living  on 3/2/2023 with hypoxia, and he was found to have COVID-pneumonia.  Since patient required oxygen, patient was treated with Decadron and remdesivir.  Patient's symptoms improved.  Patient still requires oxygen, therefore, he will be discharged with 2 L nasal cannula.  Patient completed remdesivir 5 days treatment in the hospital.  Patiently discharged with Decadron to complete a 10-day treatment.        Assessment and Plan   COVID pneumonia - Presented with: cough, sob, hypoxia  - Symptom onset: 2/28 - Positive COVID-19: 3/2/23 at ED  - Vaccination status: Vaccinated and boosted X 5.  He also had COVID in 12/2022  - CTPE on admission showed multilobar pneumonia  - Oxygen status: Patient be discharged with 2L nasal cannula O2 - Decadron: Patient be discharged with Decadron to complete 10-day course - Remdesivir: Completed 5-day course in the hospital - Serial COVID labs ordered: yes.  CRP improved (from 104.5 down to 55.6).   Acute hypoxic respiratory failure  -Secondary to above  - CTPA negative for PE but did show multilobar pneumonia  -Patiently discharged with home O2   Recurrent UTI  - pt with recurrent UTI's despite suppressive antibiotics -Urine culture positive for Enterococcus -Patient has been treated with ampicillin while in the hospital.  He will be discharged with Macrobid x7 days.   Common variable immunodeficiency -Follows with Dr. of allergy and immunology -Undergoes IgG infusion every 28 days at home with home health Constipation  Possible history of microscopic colitis - history of c diff, now with constipation  - CTPA shows large stool burden - Constipation has resolved -Continue with MiraLAX and senna twice daily -Daughter will continue to wean entocort as an outpatient    Essential HTN -Continue amlodipine    Dementia -No history of agitation -Not on medications   Chronic thrombocytopenia -Stable   Chronic venous insufficiency with BLE edema -Continue with compression hose
Age: 95.0
Sex: M
Vaccine: COVID19-2
Symptoms: Peripheral venous disease, Pneumonia, SARS-CoV-2 test positive, Thrombocytopenia, Urinary tract infection
Clinical narrative: Patient is a 95 y.o. male who presented from  independent living  on 3/2/2023 with hypoxia, and he was found to have COVID-pneumonia.  Since patient required oxygen, patient was treated with Decadron and remdesivir.  Patient's symptoms improved.  Patient still requires oxygen, therefore, he will be discharged with 2 L nasal cannula.  Patient completed remdesivir 5 days treatment in the hospital.  Patiently discharged with Decadron to complete a 10-day treatment.        Assessment and Plan   COVID pneumonia - Presented with: cough, sob, hypoxia  - Symptom onset: 2/28 - Positive COVID-19: 3/2/23 at ED  - Vaccination status: Vaccinated and boosted X 5.  He also had COVID in 12/2022  - CTPE on admission showed multilobar pneumonia  - Oxygen status: Patient be discharged with 2L nasal cannula O2 - Decadron: Patient be discharged with Decadron to complete 10-day course - Remdesivir: Completed 5-day course in the hospital - Serial COVID labs ordered: yes.  CRP improved (from 104.5 down to 55.6).   Acute hypoxic respiratory failure  -Secondary to above  - CTPA negative for PE but did show multilobar pneumonia  -Patiently discharged with home O2   Recurrent UTI  - pt with recurrent UTI's despite suppressive antibiotics -Urine culture positive for Enterococcus -Patient has been treated with ampicillin while in the hospital.  He will be discharged with Macrobid x7 days.   Common variable immunodeficiency -Follows with Dr. of allergy and immunology -Undergoes IgG infusion every 28 days at home with home health Constipation  Possible history of microscopic colitis - history of c diff, now with constipation  - CTPA shows large stool burden - Constipation has resolved -Continue with MiraLAX and senna twice daily -Daughter will continue to wean entocort as an outpatient    Essential HTN -Continue amlodipine    Dementia -No history of agitation -Not on medications   Chronic thrombocytopenia -Stable   Chronic venous insufficiency with BLE edema -Continue with compression hose
Age: 7.0
Sex: F
Vaccine: FLU4
Symptoms: Injection site erythema, Injection site pain
Clinical narrative: this morning the patient woke up and noted that her right upper arm was sore and there was a red patch surrounding the vaccine site, no fevers, no meds given, pt came to clinic for eval
Age: 68.0
Sex: M
Vaccine: COVID19
Symptoms: Incorrect product formulation administered
Clinical narrative: Patient accidentally administered Pfizer 12+ monovalent.  Patient was due for Pfizer 12+ bivalent booster.  Both presentations are almost identical in appearance and pertain to the same grey cap.  Patient was called but unable to get a hold of him.
Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Atrial fibrillation, Blood creatinine increased, Blood culture negative
Clinical narrative: Patient is a 83 y.o. female patient with history of CAD, paroxysmal A-fib on anticoagulation, ischemic cardiomyopathy, diabetes type 2 insulin-dependent, hypertension, dyslipidemia brought in to Hospital with altered mental status and acute respiratory failure.   Acute hypoxic respiratory failure, resolved COVID-19 On admission O2 sat 60%, required NRB and later transitioned to BiPAP in the ED but was able to wean down to RA COVID test positive on 2/14. CRP 132.1> 37 Patient completed isolation. Speech evaluated.  Recommended ground meats and thin liquids. Enrolled in hospice at discharge.  DC home with hospice   C. Difficile Placed on oral vancomycin and continued at discharge to complete 10 days course Isolation precautions Diarrhea improved Continues with poor oral intake  Metabolic encephalopathy, improved Lewy body dementia Patient was hard to arouse in the ER Likely due to hypoxia and UTI. Urine drug screen positive for opiates but patient not on opiates at nursing home. Responded some to Narcan CT brain-no acute intracranial abnormality. Unable to do MRI brain due to pacemaker Recurrent admissions for altered mental status Consulted neurology-waxing and waning mentation consistent with Lewy body dementia potentially exacerbated by recurrent infections. Continue Aricept and Namenda.   Urinary tract infection Urine culture:> 100,000 Enterobacter cloacae Blood cx NGTD Completed antibiotic therapy     Paroxysmal A-fib Ischemic cardiomyopathy S/p DCCV on 2/2/2023, now in sinus rhythm Continue metoprolol, amiodarone 200 mg daily   Hypertension Blood pressure stable continue Toprol-XL 25 daily   Diabetes type 2 insulin-dependent Home Rx; Lispro SSI.   Patient was hyperglycemic initially likely due to steroid and was started on Lantus but titrated down to 5 units HS and DC home on same dose. As patient is enrolling in hospice discontinued lispro SSI AC&HS Hemoglobin A1c from 1/29/2023--6.5% AKI on CKD stage III, resolved Baseline creatinine around 1.5. Admit Cr 1.6, trended up to 2.0, trended down to 1.11 Hydrated with IV fluids Held home Aldactone 12.5 mg daily but restarted No further blood draws.   Goals of Care CODE STATUS: DNR CCA Patient was not eating or drinking, not participating in therapy. Discussed with daughter about the option of feeding tube/hospice Daughter wants hospice to be consulted.  Hospice saw patient.  Patient not a candidate for inpatient hospice. DC home with hospice
Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: C-reactive protein increased, COVID-19, Clostridium difficile infection, Computerised tomogram head normal, Condition aggravated
Clinical narrative: Patient is a 83 y.o. female patient with history of CAD, paroxysmal A-fib on anticoagulation, ischemic cardiomyopathy, diabetes type 2 insulin-dependent, hypertension, dyslipidemia brought in to Hospital with altered mental status and acute respiratory failure.   Acute hypoxic respiratory failure, resolved COVID-19 On admission O2 sat 60%, required NRB and later transitioned to BiPAP in the ED but was able to wean down to RA COVID test positive on 2/14. CRP 132.1> 37 Patient completed isolation. Speech evaluated.  Recommended ground meats and thin liquids. Enrolled in hospice at discharge.  DC home with hospice   C. Difficile Placed on oral vancomycin and continued at discharge to complete 10 days course Isolation precautions Diarrhea improved Continues with poor oral intake  Metabolic encephalopathy, improved Lewy body dementia Patient was hard to arouse in the ER Likely due to hypoxia and UTI. Urine drug screen positive for opiates but patient not on opiates at nursing home. Responded some to Narcan CT brain-no acute intracranial abnormality. Unable to do MRI brain due to pacemaker Recurrent admissions for altered mental status Consulted neurology-waxing and waning mentation consistent with Lewy body dementia potentially exacerbated by recurrent infections. Continue Aricept and Namenda.   Urinary tract infection Urine culture:> 100,000 Enterobacter cloacae Blood cx NGTD Completed antibiotic therapy     Paroxysmal A-fib Ischemic cardiomyopathy S/p DCCV on 2/2/2023, now in sinus rhythm Continue metoprolol, amiodarone 200 mg daily   Hypertension Blood pressure stable continue Toprol-XL 25 daily   Diabetes type 2 insulin-dependent Home Rx; Lispro SSI.   Patient was hyperglycemic initially likely due to steroid and was started on Lantus but titrated down to 5 units HS and DC home on same dose. As patient is enrolling in hospice discontinued lispro SSI AC&HS Hemoglobin A1c from 1/29/2023--6.5% AKI on CKD stage III, resolved Baseline creatinine around 1.5. Admit Cr 1.6, trended up to 2.0, trended down to 1.11 Hydrated with IV fluids Held home Aldactone 12.5 mg daily but restarted No further blood draws.   Goals of Care CODE STATUS: DNR CCA Patient was not eating or drinking, not participating in therapy. Discussed with daughter about the option of feeding tube/hospice Daughter wants hospice to be consulted.  Hospice saw patient.  Patient not a candidate for inpatient hospice. DC home with hospice
Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: Culture urine positive, Dementia with Lewy bodies, Depressed level of consciousness, Diarrhoea, Drug screen positive
Clinical narrative: Patient is a 83 y.o. female patient with history of CAD, paroxysmal A-fib on anticoagulation, ischemic cardiomyopathy, diabetes type 2 insulin-dependent, hypertension, dyslipidemia brought in to Hospital with altered mental status and acute respiratory failure.   Acute hypoxic respiratory failure, resolved COVID-19 On admission O2 sat 60%, required NRB and later transitioned to BiPAP in the ED but was able to wean down to RA COVID test positive on 2/14. CRP 132.1> 37 Patient completed isolation. Speech evaluated.  Recommended ground meats and thin liquids. Enrolled in hospice at discharge.  DC home with hospice   C. Difficile Placed on oral vancomycin and continued at discharge to complete 10 days course Isolation precautions Diarrhea improved Continues with poor oral intake  Metabolic encephalopathy, improved Lewy body dementia Patient was hard to arouse in the ER Likely due to hypoxia and UTI. Urine drug screen positive for opiates but patient not on opiates at nursing home. Responded some to Narcan CT brain-no acute intracranial abnormality. Unable to do MRI brain due to pacemaker Recurrent admissions for altered mental status Consulted neurology-waxing and waning mentation consistent with Lewy body dementia potentially exacerbated by recurrent infections. Continue Aricept and Namenda.   Urinary tract infection Urine culture:> 100,000 Enterobacter cloacae Blood cx NGTD Completed antibiotic therapy     Paroxysmal A-fib Ischemic cardiomyopathy S/p DCCV on 2/2/2023, now in sinus rhythm Continue metoprolol, amiodarone 200 mg daily   Hypertension Blood pressure stable continue Toprol-XL 25 daily   Diabetes type 2 insulin-dependent Home Rx; Lispro SSI.   Patient was hyperglycemic initially likely due to steroid and was started on Lantus but titrated down to 5 units HS and DC home on same dose. As patient is enrolling in hospice discontinued lispro SSI AC&HS Hemoglobin A1c from 1/29/2023--6.5% AKI on CKD stage III, resolved Baseline creatinine around 1.5. Admit Cr 1.6, trended up to 2.0, trended down to 1.11 Hydrated with IV fluids Held home Aldactone 12.5 mg daily but restarted No further blood draws.   Goals of Care CODE STATUS: DNR CCA Patient was not eating or drinking, not participating in therapy. Discussed with daughter about the option of feeding tube/hospice Daughter wants hospice to be consulted.  Hospice saw patient.  Patient not a candidate for inpatient hospice. DC home with hospice
Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: Enterobacter test positive, Glycosylated haemoglobin normal, Hyperglycaemia, Hypophagia, Ischaemic cardiomyopathy
Clinical narrative: Patient is a 83 y.o. female patient with history of CAD, paroxysmal A-fib on anticoagulation, ischemic cardiomyopathy, diabetes type 2 insulin-dependent, hypertension, dyslipidemia brought in to Hospital with altered mental status and acute respiratory failure.   Acute hypoxic respiratory failure, resolved COVID-19 On admission O2 sat 60%, required NRB and later transitioned to BiPAP in the ED but was able to wean down to RA COVID test positive on 2/14. CRP 132.1> 37 Patient completed isolation. Speech evaluated.  Recommended ground meats and thin liquids. Enrolled in hospice at discharge.  DC home with hospice   C. Difficile Placed on oral vancomycin and continued at discharge to complete 10 days course Isolation precautions Diarrhea improved Continues with poor oral intake  Metabolic encephalopathy, improved Lewy body dementia Patient was hard to arouse in the ER Likely due to hypoxia and UTI. Urine drug screen positive for opiates but patient not on opiates at nursing home. Responded some to Narcan CT brain-no acute intracranial abnormality. Unable to do MRI brain due to pacemaker Recurrent admissions for altered mental status Consulted neurology-waxing and waning mentation consistent with Lewy body dementia potentially exacerbated by recurrent infections. Continue Aricept and Namenda.   Urinary tract infection Urine culture:> 100,000 Enterobacter cloacae Blood cx NGTD Completed antibiotic therapy     Paroxysmal A-fib Ischemic cardiomyopathy S/p DCCV on 2/2/2023, now in sinus rhythm Continue metoprolol, amiodarone 200 mg daily   Hypertension Blood pressure stable continue Toprol-XL 25 daily   Diabetes type 2 insulin-dependent Home Rx; Lispro SSI.   Patient was hyperglycemic initially likely due to steroid and was started on Lantus but titrated down to 5 units HS and DC home on same dose. As patient is enrolling in hospice discontinued lispro SSI AC&HS Hemoglobin A1c from 1/29/2023--6.5% AKI on CKD stage III, resolved Baseline creatinine around 1.5. Admit Cr 1.6, trended up to 2.0, trended down to 1.11 Hydrated with IV fluids Held home Aldactone 12.5 mg daily but restarted No further blood draws.   Goals of Care CODE STATUS: DNR CCA Patient was not eating or drinking, not participating in therapy. Discussed with daughter about the option of feeding tube/hospice Daughter wants hospice to be consulted.  Hospice saw patient.  Patient not a candidate for inpatient hospice. DC home with hospice
Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: Mental status changes, Metabolic encephalopathy, Opiates positive, Positive airway pressure therapy, SARS-CoV-2 test positive
Clinical narrative: Patient is a 83 y.o. female patient with history of CAD, paroxysmal A-fib on anticoagulation, ischemic cardiomyopathy, diabetes type 2 insulin-dependent, hypertension, dyslipidemia brought in to Hospital with altered mental status and acute respiratory failure.   Acute hypoxic respiratory failure, resolved COVID-19 On admission O2 sat 60%, required NRB and later transitioned to BiPAP in the ED but was able to wean down to RA COVID test positive on 2/14. CRP 132.1> 37 Patient completed isolation. Speech evaluated.  Recommended ground meats and thin liquids. Enrolled in hospice at discharge.  DC home with hospice   C. Difficile Placed on oral vancomycin and continued at discharge to complete 10 days course Isolation precautions Diarrhea improved Continues with poor oral intake  Metabolic encephalopathy, improved Lewy body dementia Patient was hard to arouse in the ER Likely due to hypoxia and UTI. Urine drug screen positive for opiates but patient not on opiates at nursing home. Responded some to Narcan CT brain-no acute intracranial abnormality. Unable to do MRI brain due to pacemaker Recurrent admissions for altered mental status Consulted neurology-waxing and waning mentation consistent with Lewy body dementia potentially exacerbated by recurrent infections. Continue Aricept and Namenda.   Urinary tract infection Urine culture:> 100,000 Enterobacter cloacae Blood cx NGTD Completed antibiotic therapy     Paroxysmal A-fib Ischemic cardiomyopathy S/p DCCV on 2/2/2023, now in sinus rhythm Continue metoprolol, amiodarone 200 mg daily   Hypertension Blood pressure stable continue Toprol-XL 25 daily   Diabetes type 2 insulin-dependent Home Rx; Lispro SSI.   Patient was hyperglycemic initially likely due to steroid and was started on Lantus but titrated down to 5 units HS and DC home on same dose. As patient is enrolling in hospice discontinued lispro SSI AC&HS Hemoglobin A1c from 1/29/2023--6.5% AKI on CKD stage III, resolved Baseline creatinine around 1.5. Admit Cr 1.6, trended up to 2.0, trended down to 1.11 Hydrated with IV fluids Held home Aldactone 12.5 mg daily but restarted No further blood draws.   Goals of Care CODE STATUS: DNR CCA Patient was not eating or drinking, not participating in therapy. Discussed with daughter about the option of feeding tube/hospice Daughter wants hospice to be consulted.  Hospice saw patient.  Patient not a candidate for inpatient hospice. DC home with hospice
Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: Sinus rhythm, Urinary tract infection
Clinical narrative: Patient is a 83 y.o. female patient with history of CAD, paroxysmal A-fib on anticoagulation, ischemic cardiomyopathy, diabetes type 2 insulin-dependent, hypertension, dyslipidemia brought in to Hospital with altered mental status and acute respiratory failure.   Acute hypoxic respiratory failure, resolved COVID-19 On admission O2 sat 60%, required NRB and later transitioned to BiPAP in the ED but was able to wean down to RA COVID test positive on 2/14. CRP 132.1> 37 Patient completed isolation. Speech evaluated.  Recommended ground meats and thin liquids. Enrolled in hospice at discharge.  DC home with hospice   C. Difficile Placed on oral vancomycin and continued at discharge to complete 10 days course Isolation precautions Diarrhea improved Continues with poor oral intake  Metabolic encephalopathy, improved Lewy body dementia Patient was hard to arouse in the ER Likely due to hypoxia and UTI. Urine drug screen positive for opiates but patient not on opiates at nursing home. Responded some to Narcan CT brain-no acute intracranial abnormality. Unable to do MRI brain due to pacemaker Recurrent admissions for altered mental status Consulted neurology-waxing and waning mentation consistent with Lewy body dementia potentially exacerbated by recurrent infections. Continue Aricept and Namenda.   Urinary tract infection Urine culture:> 100,000 Enterobacter cloacae Blood cx NGTD Completed antibiotic therapy     Paroxysmal A-fib Ischemic cardiomyopathy S/p DCCV on 2/2/2023, now in sinus rhythm Continue metoprolol, amiodarone 200 mg daily   Hypertension Blood pressure stable continue Toprol-XL 25 daily   Diabetes type 2 insulin-dependent Home Rx; Lispro SSI.   Patient was hyperglycemic initially likely due to steroid and was started on Lantus but titrated down to 5 units HS and DC home on same dose. As patient is enrolling in hospice discontinued lispro SSI AC&HS Hemoglobin A1c from 1/29/2023--6.5% AKI on CKD stage III, resolved Baseline creatinine around 1.5. Admit Cr 1.6, trended up to 2.0, trended down to 1.11 Hydrated with IV fluids Held home Aldactone 12.5 mg daily but restarted No further blood draws.   Goals of Care CODE STATUS: DNR CCA Patient was not eating or drinking, not participating in therapy. Discussed with daughter about the option of feeding tube/hospice Daughter wants hospice to be consulted.  Hospice saw patient.  Patient not a candidate for inpatient hospice. DC home with hospice
Age: 54.0
Sex: F
Vaccine: TDAP
Symptoms: Erythema, Pain, Pruritus, Swelling
Clinical narrative: Patient came to pharmacy on 03/31/2023 and informed that she had redness,bump and swelling after she got the boostrix vaccine on 03/18/2023 which became worst after 4 days. It was itchy, painful and swollen. Now she is getting better, but she is still a little itchy, has redness and some pain. Patient also informed me that the redness traveled down her arm. Recommended patient to see a doctor.
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Amputation, Anticoagulant therapy, Arterial occlusive disease, Arterial recanalisation procedure
Clinical narrative: Patient is a 76 y.o. male patient of Physician No with history of ESRD on HD, T2DM, HTN, HFpEF, PAF who presented to ED for direct admission to Podiatry for scheduled surgery; however found to be hypoxemic and COVID + in ED. S/p LLE vascular intervention, and left foot partial amputation with podiatry. Osteomyelitis of left 4th metatarsal Patient/family report wound present for several months, but recent increase in fluid output from wound Directed to ED by Podiatry for admission NIVS with severe LLE PAD requiring revascularization prior to podiatry intervention, see below Wound cx polymicrobial, bcx NGTD WBC 4.0 CRP 61 ESR 27 SIRS negative Empiric vanc/zosyn from 2/22 > cx with normal flora, narrowed to unasyn 2/24, continue through time of source control Pre op stress test with infarct, mild peri infarct ischemia. OK for OR from cardiology Status post left foot partial amputation 2/28 Operative sample from the amputation margin pathology showed osteomyelitis Infectious disease following: Ancef with HD through 4/12   PAD Known LLE PAD and reportedly had a revascularization 1 month ago s/p RLE disarticulation LLE arterial duplex with 50-99% stenosis in the left distal SFA and proximal PT. Occlusion noted in the left mid and distal AT. S/p L AT PTA and L PT recanalization via L brachial artery cutdown 2/24 with vascular surgery ASA continues, plavix loaded, hep gtt per vascular until OR with podiatry then switched to eliquis; per discussion with Dr., plan to continue all 3 for the time being post op until vascular surgery follow up on 03/15 (Discussed with vascular team) Continue statin   Covid-19 Virus Infection Date of onset of symptoms: 2/21/2023           Symptoms present on admission: Dyspnea Date of covid positive test: 2/21/2023 Vaccination status: vaccinated x4, last given 10/2023 Imaging: CXR w/patchy bilateral airspace disease Oxygen requirements on admission: 2-3L NC Current oxygen requirements: RA Medical therapy: steroids, stopped after 2/23 given stable on RA Special isolation end date: 3/3/2023   Elevated Troponin Coronary artery calcification Abnormal echocardiogram Asymptomatic, suspect largely demand ischemia Initial troponin 112 > 105 Initial EKG w/o acute ischemic changes Resume home statin, ASA LDL 39, A1c 6.0 Monitor on tele Echo with focal WMA, stress as above Cardiology consulted, OK for OR   Essential HTN Chronic, w/soft BP PTA Home amlodipine held on admission Monitor and resume PRN   Chronic/stable conditions: AHRF/pleural effusion- s/p thora for 1.6L, transudative, stable on RA ESRD- on HD MWF, renal following T2DM, insulin dependent- on SSI only, continue PAF- on low dose eliquis at home, does not meet criteria for dose reduction but consider low dose with ongoing DAPT Obesity OSA/OHS- noncompliant with home CPAP, AutoPAP ordered but patient has been refusing
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Arteriosclerosis coronary artery, Blood culture negative, C-reactive protein increased, COVID-19, Cardiac stress test abnormal
Clinical narrative: Patient is a 76 y.o. male patient of Physician No with history of ESRD on HD, T2DM, HTN, HFpEF, PAF who presented to ED for direct admission to Podiatry for scheduled surgery; however found to be hypoxemic and COVID + in ED. S/p LLE vascular intervention, and left foot partial amputation with podiatry. Osteomyelitis of left 4th metatarsal Patient/family report wound present for several months, but recent increase in fluid output from wound Directed to ED by Podiatry for admission NIVS with severe LLE PAD requiring revascularization prior to podiatry intervention, see below Wound cx polymicrobial, bcx NGTD WBC 4.0 CRP 61 ESR 27 SIRS negative Empiric vanc/zosyn from 2/22 > cx with normal flora, narrowed to unasyn 2/24, continue through time of source control Pre op stress test with infarct, mild peri infarct ischemia. OK for OR from cardiology Status post left foot partial amputation 2/28 Operative sample from the amputation margin pathology showed osteomyelitis Infectious disease following: Ancef with HD through 4/12   PAD Known LLE PAD and reportedly had a revascularization 1 month ago s/p RLE disarticulation LLE arterial duplex with 50-99% stenosis in the left distal SFA and proximal PT. Occlusion noted in the left mid and distal AT. S/p L AT PTA and L PT recanalization via L brachial artery cutdown 2/24 with vascular surgery ASA continues, plavix loaded, hep gtt per vascular until OR with podiatry then switched to eliquis; per discussion with Dr., plan to continue all 3 for the time being post op until vascular surgery follow up on 03/15 (Discussed with vascular team) Continue statin   Covid-19 Virus Infection Date of onset of symptoms: 2/21/2023           Symptoms present on admission: Dyspnea Date of covid positive test: 2/21/2023 Vaccination status: vaccinated x4, last given 10/2023 Imaging: CXR w/patchy bilateral airspace disease Oxygen requirements on admission: 2-3L NC Current oxygen requirements: RA Medical therapy: steroids, stopped after 2/23 given stable on RA Special isolation end date: 3/3/2023   Elevated Troponin Coronary artery calcification Abnormal echocardiogram Asymptomatic, suspect largely demand ischemia Initial troponin 112 > 105 Initial EKG w/o acute ischemic changes Resume home statin, ASA LDL 39, A1c 6.0 Monitor on tele Echo with focal WMA, stress as above Cardiology consulted, OK for OR   Essential HTN Chronic, w/soft BP PTA Home amlodipine held on admission Monitor and resume PRN   Chronic/stable conditions: AHRF/pleural effusion- s/p thora for 1.6L, transudative, stable on RA ESRD- on HD MWF, renal following T2DM, insulin dependent- on SSI only, continue PAF- on low dose eliquis at home, does not meet criteria for dose reduction but consider low dose with ongoing DAPT Obesity OSA/OHS- noncompliant with home CPAP, AutoPAP ordered but patient has been refusing
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Cardiac telemetry, Chest X-ray, Culture wound, Dyspnoea, Echocardiogram abnormal
Clinical narrative: Patient is a 76 y.o. male patient of Physician No with history of ESRD on HD, T2DM, HTN, HFpEF, PAF who presented to ED for direct admission to Podiatry for scheduled surgery; however found to be hypoxemic and COVID + in ED. S/p LLE vascular intervention, and left foot partial amputation with podiatry. Osteomyelitis of left 4th metatarsal Patient/family report wound present for several months, but recent increase in fluid output from wound Directed to ED by Podiatry for admission NIVS with severe LLE PAD requiring revascularization prior to podiatry intervention, see below Wound cx polymicrobial, bcx NGTD WBC 4.0 CRP 61 ESR 27 SIRS negative Empiric vanc/zosyn from 2/22 > cx with normal flora, narrowed to unasyn 2/24, continue through time of source control Pre op stress test with infarct, mild peri infarct ischemia. OK for OR from cardiology Status post left foot partial amputation 2/28 Operative sample from the amputation margin pathology showed osteomyelitis Infectious disease following: Ancef with HD through 4/12   PAD Known LLE PAD and reportedly had a revascularization 1 month ago s/p RLE disarticulation LLE arterial duplex with 50-99% stenosis in the left distal SFA and proximal PT. Occlusion noted in the left mid and distal AT. S/p L AT PTA and L PT recanalization via L brachial artery cutdown 2/24 with vascular surgery ASA continues, plavix loaded, hep gtt per vascular until OR with podiatry then switched to eliquis; per discussion with Dr., plan to continue all 3 for the time being post op until vascular surgery follow up on 03/15 (Discussed with vascular team) Continue statin   Covid-19 Virus Infection Date of onset of symptoms: 2/21/2023           Symptoms present on admission: Dyspnea Date of covid positive test: 2/21/2023 Vaccination status: vaccinated x4, last given 10/2023 Imaging: CXR w/patchy bilateral airspace disease Oxygen requirements on admission: 2-3L NC Current oxygen requirements: RA Medical therapy: steroids, stopped after 2/23 given stable on RA Special isolation end date: 3/3/2023   Elevated Troponin Coronary artery calcification Abnormal echocardiogram Asymptomatic, suspect largely demand ischemia Initial troponin 112 > 105 Initial EKG w/o acute ischemic changes Resume home statin, ASA LDL 39, A1c 6.0 Monitor on tele Echo with focal WMA, stress as above Cardiology consulted, OK for OR   Essential HTN Chronic, w/soft BP PTA Home amlodipine held on admission Monitor and resume PRN   Chronic/stable conditions: AHRF/pleural effusion- s/p thora for 1.6L, transudative, stable on RA ESRD- on HD MWF, renal following T2DM, insulin dependent- on SSI only, continue PAF- on low dose eliquis at home, does not meet criteria for dose reduction but consider low dose with ongoing DAPT Obesity OSA/OHS- noncompliant with home CPAP, AutoPAP ordered but patient has been refusing
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Electrocardiogram normal, Essential hypertension, Foot amputation, Glycosylated haemoglobin normal, Haemodialysis
Clinical narrative: Patient is a 76 y.o. male patient of Physician No with history of ESRD on HD, T2DM, HTN, HFpEF, PAF who presented to ED for direct admission to Podiatry for scheduled surgery; however found to be hypoxemic and COVID + in ED. S/p LLE vascular intervention, and left foot partial amputation with podiatry. Osteomyelitis of left 4th metatarsal Patient/family report wound present for several months, but recent increase in fluid output from wound Directed to ED by Podiatry for admission NIVS with severe LLE PAD requiring revascularization prior to podiatry intervention, see below Wound cx polymicrobial, bcx NGTD WBC 4.0 CRP 61 ESR 27 SIRS negative Empiric vanc/zosyn from 2/22 > cx with normal flora, narrowed to unasyn 2/24, continue through time of source control Pre op stress test with infarct, mild peri infarct ischemia. OK for OR from cardiology Status post left foot partial amputation 2/28 Operative sample from the amputation margin pathology showed osteomyelitis Infectious disease following: Ancef with HD through 4/12   PAD Known LLE PAD and reportedly had a revascularization 1 month ago s/p RLE disarticulation LLE arterial duplex with 50-99% stenosis in the left distal SFA and proximal PT. Occlusion noted in the left mid and distal AT. S/p L AT PTA and L PT recanalization via L brachial artery cutdown 2/24 with vascular surgery ASA continues, plavix loaded, hep gtt per vascular until OR with podiatry then switched to eliquis; per discussion with Dr., plan to continue all 3 for the time being post op until vascular surgery follow up on 03/15 (Discussed with vascular team) Continue statin   Covid-19 Virus Infection Date of onset of symptoms: 2/21/2023           Symptoms present on admission: Dyspnea Date of covid positive test: 2/21/2023 Vaccination status: vaccinated x4, last given 10/2023 Imaging: CXR w/patchy bilateral airspace disease Oxygen requirements on admission: 2-3L NC Current oxygen requirements: RA Medical therapy: steroids, stopped after 2/23 given stable on RA Special isolation end date: 3/3/2023   Elevated Troponin Coronary artery calcification Abnormal echocardiogram Asymptomatic, suspect largely demand ischemia Initial troponin 112 > 105 Initial EKG w/o acute ischemic changes Resume home statin, ASA LDL 39, A1c 6.0 Monitor on tele Echo with focal WMA, stress as above Cardiology consulted, OK for OR   Essential HTN Chronic, w/soft BP PTA Home amlodipine held on admission Monitor and resume PRN   Chronic/stable conditions: AHRF/pleural effusion- s/p thora for 1.6L, transudative, stable on RA ESRD- on HD MWF, renal following T2DM, insulin dependent- on SSI only, continue PAF- on low dose eliquis at home, does not meet criteria for dose reduction but consider low dose with ongoing DAPT Obesity OSA/OHS- noncompliant with home CPAP, AutoPAP ordered but patient has been refusing