chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 25.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Asthenia, COVID-19, Computerised tomogram thorax normal, Fatigue, Inflammatory marker increased
Clinical narrative: 7/30--8/3 25 yo gentleman with history of obesity, mitral regurgitation admitted with fever, malaise, fatigue, weakness and hoome test positive for  COVID 19. Currently on room air. Non-hypoxic. Elevated inflammatory markers. Patient mid to the hospital seen by infectious disease placed in COVID isolation received IV Decadron remained stable and continued to improve had lower extremity venous Doppler CT of the chest negative for pulmonary embolism or DVT continue to improve was felt to be stable for discharge
Age: 25.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Malaise, Pyrexia, SARS-CoV-2 test positive, Ultrasound Doppler normal
Clinical narrative: 7/30--8/3 25 yo gentleman with history of obesity, mitral regurgitation admitted with fever, malaise, fatigue, weakness and hoome test positive for  COVID 19. Currently on room air. Non-hypoxic. Elevated inflammatory markers. Patient mid to the hospital seen by infectious disease placed in COVID isolation received IV Decadron remained stable and continued to improve had lower extremity venous Doppler CT of the chest negative for pulmonary embolism or DVT continue to improve was felt to be stable for discharge
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Cardiac procedure complication, Haemostasis, Intensive care, Obesity
Clinical narrative: 7/15-7/19: 88-year-old female (PMH significant for CAD, s/p CABG, A Fib, HTN and hyperlipidemia) presented on 7/15/2022 from home for outpatient care. Within the procedure, difficulty obtaining vascular access in the left groin due to adiposity despite attempts with 6F and 5F sheaths. A large superficial tear exposed adipose tissue during manual pressure and vascular surgery was called. Hemostasis achieved. The skin was sutured in the lab. Patient transferred to CCU for further monitoring. Since that time, patient cleared by vascular surgery. She has been having wound care within the CCU. Patient reevaluated today and stable for discharge at this time.
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Percutaneous coronary intervention, SARS-CoV-2 test positive, Suture insertion
Clinical narrative: 7/15-7/19: 88-year-old female (PMH significant for CAD, s/p CABG, A Fib, HTN and hyperlipidemia) presented on 7/15/2022 from home for outpatient care. Within the procedure, difficulty obtaining vascular access in the left groin due to adiposity despite attempts with 6F and 5F sheaths. A large superficial tear exposed adipose tissue during manual pressure and vascular surgery was called. Hemostasis achieved. The skin was sutured in the lab. Patient transferred to CCU for further monitoring. Since that time, patient cleared by vascular surgery. She has been having wound care within the CCU. Patient reevaluated today and stable for discharge at this time.
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Basal ganglia haemorrhage, COVID-19, Cerebral haematoma, Computerised tomogram head abnormal, Computerised tomogram thorax abnormal
Clinical narrative: PFIZER COVID VACCINE #3 GIVEN 9/23/21, LOT #30145BA; limited medical records received on pt; 2/22/22 pt to ED via EMS after hitting head during a fall; pt became unresponsive en route to hospital; intubated in ED; CT head showed right basal ganglia hemorrhage and right occipital hematoma; hypertensive bleed; CT chest showed bilateral pneumonia; positive COVID test; pt transferred to ICU; 5 days later pt passed away in the hospital
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Death, Endotracheal intubation, Fall, Haemorrhage, Head injury
Clinical narrative: PFIZER COVID VACCINE #3 GIVEN 9/23/21, LOT #30145BA; limited medical records received on pt; 2/22/22 pt to ED via EMS after hitting head during a fall; pt became unresponsive en route to hospital; intubated in ED; CT head showed right basal ganglia hemorrhage and right occipital hematoma; hypertensive bleed; CT chest showed bilateral pneumonia; positive COVID test; pt transferred to ICU; 5 days later pt passed away in the hospital
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Hypertension, Intensive care, Pneumonia, SARS-CoV-2 test positive, Unresponsive to stimuli
Clinical narrative: PFIZER COVID VACCINE #3 GIVEN 9/23/21, LOT #30145BA; limited medical records received on pt; 2/22/22 pt to ED via EMS after hitting head during a fall; pt became unresponsive en route to hospital; intubated in ED; CT head showed right basal ganglia hemorrhage and right occipital hematoma; hypertensive bleed; CT chest showed bilateral pneumonia; positive COVID test; pt transferred to ICU; 5 days later pt passed away in the hospital
Age: 52.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: COVID-19, Defect conduction intraventricular, Dyspnoea, Peripheral swelling, SARS-CoV-2 test positive
Clinical narrative: 8/2--presently admitted 52y.o. male with PMH including NICM EF 10%, HFrEF, hx DVT and PE, DM2, CKD, HTN, PAF on warfarin, lisinopril allergy who presented for SOB x 2-3 days a/w BL leg swelling. His daughter was recently diagnosed with COVID-19 and his test in the ER is positive. He was previously evaluated in the office for ICD and CRT-D was recommended. He was originally interested, but decided not to schedule it. He is now interested in getting an ICD. He has wide IVCD so plan for CRT-D with EP physician. Will have our office schedule this as an outpatient once he has recovered from COVID/is out of isolation.Continue GDMT with BB with Coreg 3.125mg BID, Valsartan 40mg daily and Aldactone 25mg daily
Age: 52.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: COVID-19, Dyspnoea, Echocardiogram abnormal, Ejection fraction decreased, Exposure to SARS-CoV-2
Clinical narrative: 8/2--presently admitted 52y.o. male with PMH including NICM EF 10%, HFrEF, hx DVT and PE, DM2, CKD, HTN, PAF on warfarin, lisinopril allergy who presented for SOB x 2-3 days a/w BL leg swelling. His daughter was recently diagnosed with COVID-19 and his test in the ER is positive. He was previously evaluated in the office for ICD and CRT-D was recommended. He was originally interested, but decided not to schedule it. He is now interested in getting an ICD. He has wide IVCD so plan for CRT-D with EP physician. Will have our office schedule this as an outpatient once he has recovered from COVID/is out of isolation.Continue GDMT with BB with Coreg 3.125mg BID, Valsartan 40mg daily and Aldactone 25mg daily
Age: 52.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Hypervolaemia, Left ventricular failure, Oedema peripheral, Polymerase chain reaction, SARS-CoV-2 test positive
Clinical narrative: 8/2--presently admitted 52y.o. male with PMH including NICM EF 10%, HFrEF, hx DVT and PE, DM2, CKD, HTN, PAF on warfarin, lisinopril allergy who presented for SOB x 2-3 days a/w BL leg swelling. His daughter was recently diagnosed with COVID-19 and his test in the ER is positive. He was previously evaluated in the office for ICD and CRT-D was recommended. He was originally interested, but decided not to schedule it. He is now interested in getting an ICD. He has wide IVCD so plan for CRT-D with EP physician. Will have our office schedule this as an outpatient once he has recovered from COVID/is out of isolation.Continue GDMT with BB with Coreg 3.125mg BID, Valsartan 40mg daily and Aldactone 25mg daily
Age: 61.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Arthralgia, Bone lesion, COVID-19, Cerebral mass effect, Cytoreductive surgery
Clinical narrative: 7/27--presently admitted 62y.o. man with a large right upper lobe adenocarcinoma with extensive regional mass-effect, regional lymphatic spread, and evidence for distant metastatic disease with osseous metastases throughout his axial skeleton and 3 enhancing brain metastases. The patient's oncologic history begins with 8 weeks of left shoulder and upper arm pain which ultimately prompted presentation to an Urgent Care on 7/25/2022. A shoulder xray was performed, revealing a lytic lesion in the left humeral head, suspicious for metastatic disease. Metastatic bone survey was performed on 7/28/2022, redemonstrating the lytic lesions in the left humerus, left scapula, left acetabulum, right ilium, T5, and C4. On 7/30/22 the patient underwent fixation of the patient's left humerus with tumor debulking of the humerus and right acetabulum. An MRI of the patient's brain and spine was performed on 8/1/2022, revealing three enhancing intracranial masses compatible with metastases. The patient need GK for brain lesions, and start systemic therapy. Will give b12 IM and start folic acid 1 mg daily in prep to start chemo next week.
Age: 61.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Laboratory test abnormal, Lung adenocarcinoma, Magnetic resonance imaging head abnormal, Magnetic resonance imaging spinal abnormal, Metastases to bone
Clinical narrative: 7/27--presently admitted 62y.o. man with a large right upper lobe adenocarcinoma with extensive regional mass-effect, regional lymphatic spread, and evidence for distant metastatic disease with osseous metastases throughout his axial skeleton and 3 enhancing brain metastases. The patient's oncologic history begins with 8 weeks of left shoulder and upper arm pain which ultimately prompted presentation to an Urgent Care on 7/25/2022. A shoulder xray was performed, revealing a lytic lesion in the left humeral head, suspicious for metastatic disease. Metastatic bone survey was performed on 7/28/2022, redemonstrating the lytic lesions in the left humerus, left scapula, left acetabulum, right ilium, T5, and C4. On 7/30/22 the patient underwent fixation of the patient's left humerus with tumor debulking of the humerus and right acetabulum. An MRI of the patient's brain and spine was performed on 8/1/2022, revealing three enhancing intracranial masses compatible with metastases. The patient need GK for brain lesions, and start systemic therapy. Will give b12 IM and start folic acid 1 mg daily in prep to start chemo next week.
Age: 61.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Metastases to central nervous system, Metastases to lymph nodes, Metastatic neoplasm, Pain in extremity, SARS-CoV-2 test positive
Clinical narrative: 7/27--presently admitted 62y.o. man with a large right upper lobe adenocarcinoma with extensive regional mass-effect, regional lymphatic spread, and evidence for distant metastatic disease with osseous metastases throughout his axial skeleton and 3 enhancing brain metastases. The patient's oncologic history begins with 8 weeks of left shoulder and upper arm pain which ultimately prompted presentation to an Urgent Care on 7/25/2022. A shoulder xray was performed, revealing a lytic lesion in the left humeral head, suspicious for metastatic disease. Metastatic bone survey was performed on 7/28/2022, redemonstrating the lytic lesions in the left humerus, left scapula, left acetabulum, right ilium, T5, and C4. On 7/30/22 the patient underwent fixation of the patient's left humerus with tumor debulking of the humerus and right acetabulum. An MRI of the patient's brain and spine was performed on 8/1/2022, revealing three enhancing intracranial masses compatible with metastases. The patient need GK for brain lesions, and start systemic therapy. Will give b12 IM and start folic acid 1 mg daily in prep to start chemo next week.
Age: 61.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: X-ray limb abnormal
Clinical narrative: 7/27--presently admitted 62y.o. man with a large right upper lobe adenocarcinoma with extensive regional mass-effect, regional lymphatic spread, and evidence for distant metastatic disease with osseous metastases throughout his axial skeleton and 3 enhancing brain metastases. The patient's oncologic history begins with 8 weeks of left shoulder and upper arm pain which ultimately prompted presentation to an Urgent Care on 7/25/2022. A shoulder xray was performed, revealing a lytic lesion in the left humeral head, suspicious for metastatic disease. Metastatic bone survey was performed on 7/28/2022, redemonstrating the lytic lesions in the left humerus, left scapula, left acetabulum, right ilium, T5, and C4. On 7/30/22 the patient underwent fixation of the patient's left humerus with tumor debulking of the humerus and right acetabulum. An MRI of the patient's brain and spine was performed on 8/1/2022, revealing three enhancing intracranial masses compatible with metastases. The patient need GK for brain lesions, and start systemic therapy. Will give b12 IM and start folic acid 1 mg daily in prep to start chemo next week.
Age: 32.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Atelectasis, Bacterial test negative, COVID-19, Chest X-ray abnormal, Cholelithiasis
Clinical narrative: 7/23--7/27 33 y.o. male with past medical history of alcoholic cirrhosis complicated by hepatic encephalopathy who was transferred to ED from outside hospital on 07/23/22 with chief complaint of bleeding from venipuncture site and toe after trimming his nails. Patient was recently admitted for pneumonia and sepsis with a COVID positive test on 7/03 s/p monoclonal antibodies. During this visit, patient was diagnosed with bilateral pleural effusions and MRI showing psoas abscess and liver cysts. He was discharged on 07/21 with a 12 day course of ceftin and Flagyl. On 07/23, presented due to uncontrolled bleeding from his venipuncture site and toe where he was found to be thrombocytopenic with elevated coagulation parameters. Platelet infusion was started but was not completed due to patient becoming short of breath with associated edema requiring Lasix. Patient was transferred here for further management. CXR showed right perihilar opacity which may reflect pneumonia and trace left effusion. MRI showed likely psoas muscle hematoma, indeterminate medial left lobe lesion worrisome for malignancy, indeterminate anterior right lobe lesion, cirrhosis with findings of portal hypertension, splenomegaly, moderate caliber varices with patent portal vein, cholelithiasis with diffuse gallbladder wall thickening, and small pleural effusions with lung base atelectasis. US abdomen with similar findings. Repeat MRI characterized liver lesions as hemangiomas.  He was found to have significantly elevated INR with bleeding from venipuncture sites.  Patient was given 3 days 10 g vitamin K.  His INR continually decreased day by day and venipuncture bleeding ceased.  Respiratory atypical bacteria panel, legionella, and strep pneumoniae antigens were negative. Hepatology was consulted - patient does not meet criteria for further evaluation for liver transplant at this time. This was discussed by hepatology  team with the patient. We enquired hepatology about the EGD for variceal banding who recommended that it can be done as outpatient since there is no suspicion of active bleed. Also recommended that antibiotics prophylaxis was not indicated. Prior to discharge, we discussed this all with the patient. Patient was discharged in stable condition and instructed to follow-up with the specialists and PCP. All questions were answered.
Age: 32.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Coagulation factor increased, Dyspnoea, Gallbladder enlargement, Haemangioma of liver, Haematoma muscle
Clinical narrative: 7/23--7/27 33 y.o. male with past medical history of alcoholic cirrhosis complicated by hepatic encephalopathy who was transferred to ED from outside hospital on 07/23/22 with chief complaint of bleeding from venipuncture site and toe after trimming his nails. Patient was recently admitted for pneumonia and sepsis with a COVID positive test on 7/03 s/p monoclonal antibodies. During this visit, patient was diagnosed with bilateral pleural effusions and MRI showing psoas abscess and liver cysts. He was discharged on 07/21 with a 12 day course of ceftin and Flagyl. On 07/23, presented due to uncontrolled bleeding from his venipuncture site and toe where he was found to be thrombocytopenic with elevated coagulation parameters. Platelet infusion was started but was not completed due to patient becoming short of breath with associated edema requiring Lasix. Patient was transferred here for further management. CXR showed right perihilar opacity which may reflect pneumonia and trace left effusion. MRI showed likely psoas muscle hematoma, indeterminate medial left lobe lesion worrisome for malignancy, indeterminate anterior right lobe lesion, cirrhosis with findings of portal hypertension, splenomegaly, moderate caliber varices with patent portal vein, cholelithiasis with diffuse gallbladder wall thickening, and small pleural effusions with lung base atelectasis. US abdomen with similar findings. Repeat MRI characterized liver lesions as hemangiomas.  He was found to have significantly elevated INR with bleeding from venipuncture sites.  Patient was given 3 days 10 g vitamin K.  His INR continually decreased day by day and venipuncture bleeding ceased.  Respiratory atypical bacteria panel, legionella, and strep pneumoniae antigens were negative. Hepatology was consulted - patient does not meet criteria for further evaluation for liver transplant at this time. This was discussed by hepatology  team with the patient. We enquired hepatology about the EGD for variceal banding who recommended that it can be done as outpatient since there is no suspicion of active bleed. Also recommended that antibiotics prophylaxis was not indicated. Prior to discharge, we discussed this all with the patient. Patient was discharged in stable condition and instructed to follow-up with the specialists and PCP. All questions were answered.
Age: 32.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Hepatic cirrhosis, Hepatic cyst, Hepatic lesion, International normalised ratio increased, Legionella test
Clinical narrative: 7/23--7/27 33 y.o. male with past medical history of alcoholic cirrhosis complicated by hepatic encephalopathy who was transferred to ED from outside hospital on 07/23/22 with chief complaint of bleeding from venipuncture site and toe after trimming his nails. Patient was recently admitted for pneumonia and sepsis with a COVID positive test on 7/03 s/p monoclonal antibodies. During this visit, patient was diagnosed with bilateral pleural effusions and MRI showing psoas abscess and liver cysts. He was discharged on 07/21 with a 12 day course of ceftin and Flagyl. On 07/23, presented due to uncontrolled bleeding from his venipuncture site and toe where he was found to be thrombocytopenic with elevated coagulation parameters. Platelet infusion was started but was not completed due to patient becoming short of breath with associated edema requiring Lasix. Patient was transferred here for further management. CXR showed right perihilar opacity which may reflect pneumonia and trace left effusion. MRI showed likely psoas muscle hematoma, indeterminate medial left lobe lesion worrisome for malignancy, indeterminate anterior right lobe lesion, cirrhosis with findings of portal hypertension, splenomegaly, moderate caliber varices with patent portal vein, cholelithiasis with diffuse gallbladder wall thickening, and small pleural effusions with lung base atelectasis. US abdomen with similar findings. Repeat MRI characterized liver lesions as hemangiomas.  He was found to have significantly elevated INR with bleeding from venipuncture sites.  Patient was given 3 days 10 g vitamin K.  His INR continually decreased day by day and venipuncture bleeding ceased.  Respiratory atypical bacteria panel, legionella, and strep pneumoniae antigens were negative. Hepatology was consulted - patient does not meet criteria for further evaluation for liver transplant at this time. This was discussed by hepatology  team with the patient. We enquired hepatology about the EGD for variceal banding who recommended that it can be done as outpatient since there is no suspicion of active bleed. Also recommended that antibiotics prophylaxis was not indicated. Prior to discharge, we discussed this all with the patient. Patient was discharged in stable condition and instructed to follow-up with the specialists and PCP. All questions were answered.
Age: 32.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Lung neoplasm, Lung opacity, Magnetic resonance imaging abnormal, Oedema, Platelet transfusion
Clinical narrative: 7/23--7/27 33 y.o. male with past medical history of alcoholic cirrhosis complicated by hepatic encephalopathy who was transferred to ED from outside hospital on 07/23/22 with chief complaint of bleeding from venipuncture site and toe after trimming his nails. Patient was recently admitted for pneumonia and sepsis with a COVID positive test on 7/03 s/p monoclonal antibodies. During this visit, patient was diagnosed with bilateral pleural effusions and MRI showing psoas abscess and liver cysts. He was discharged on 07/21 with a 12 day course of ceftin and Flagyl. On 07/23, presented due to uncontrolled bleeding from his venipuncture site and toe where he was found to be thrombocytopenic with elevated coagulation parameters. Platelet infusion was started but was not completed due to patient becoming short of breath with associated edema requiring Lasix. Patient was transferred here for further management. CXR showed right perihilar opacity which may reflect pneumonia and trace left effusion. MRI showed likely psoas muscle hematoma, indeterminate medial left lobe lesion worrisome for malignancy, indeterminate anterior right lobe lesion, cirrhosis with findings of portal hypertension, splenomegaly, moderate caliber varices with patent portal vein, cholelithiasis with diffuse gallbladder wall thickening, and small pleural effusions with lung base atelectasis. US abdomen with similar findings. Repeat MRI characterized liver lesions as hemangiomas.  He was found to have significantly elevated INR with bleeding from venipuncture sites.  Patient was given 3 days 10 g vitamin K.  His INR continually decreased day by day and venipuncture bleeding ceased.  Respiratory atypical bacteria panel, legionella, and strep pneumoniae antigens were negative. Hepatology was consulted - patient does not meet criteria for further evaluation for liver transplant at this time. This was discussed by hepatology  team with the patient. We enquired hepatology about the EGD for variceal banding who recommended that it can be done as outpatient since there is no suspicion of active bleed. Also recommended that antibiotics prophylaxis was not indicated. Prior to discharge, we discussed this all with the patient. Patient was discharged in stable condition and instructed to follow-up with the specialists and PCP. All questions were answered.
Age: 32.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Pleural effusion, Pneumonia, Portal hypertension, Psoas abscess, Respiratory viral panel
Clinical narrative: 7/23--7/27 33 y.o. male with past medical history of alcoholic cirrhosis complicated by hepatic encephalopathy who was transferred to ED from outside hospital on 07/23/22 with chief complaint of bleeding from venipuncture site and toe after trimming his nails. Patient was recently admitted for pneumonia and sepsis with a COVID positive test on 7/03 s/p monoclonal antibodies. During this visit, patient was diagnosed with bilateral pleural effusions and MRI showing psoas abscess and liver cysts. He was discharged on 07/21 with a 12 day course of ceftin and Flagyl. On 07/23, presented due to uncontrolled bleeding from his venipuncture site and toe where he was found to be thrombocytopenic with elevated coagulation parameters. Platelet infusion was started but was not completed due to patient becoming short of breath with associated edema requiring Lasix. Patient was transferred here for further management. CXR showed right perihilar opacity which may reflect pneumonia and trace left effusion. MRI showed likely psoas muscle hematoma, indeterminate medial left lobe lesion worrisome for malignancy, indeterminate anterior right lobe lesion, cirrhosis with findings of portal hypertension, splenomegaly, moderate caliber varices with patent portal vein, cholelithiasis with diffuse gallbladder wall thickening, and small pleural effusions with lung base atelectasis. US abdomen with similar findings. Repeat MRI characterized liver lesions as hemangiomas.  He was found to have significantly elevated INR with bleeding from venipuncture sites.  Patient was given 3 days 10 g vitamin K.  His INR continually decreased day by day and venipuncture bleeding ceased.  Respiratory atypical bacteria panel, legionella, and strep pneumoniae antigens were negative. Hepatology was consulted - patient does not meet criteria for further evaluation for liver transplant at this time. This was discussed by hepatology  team with the patient. We enquired hepatology about the EGD for variceal banding who recommended that it can be done as outpatient since there is no suspicion of active bleed. Also recommended that antibiotics prophylaxis was not indicated. Prior to discharge, we discussed this all with the patient. Patient was discharged in stable condition and instructed to follow-up with the specialists and PCP. All questions were answered.
Age: 32.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: SARS-CoV-2 test positive, Sepsis, Skin laceration, Splenomegaly, Streptococcus test negative
Clinical narrative: 7/23--7/27 33 y.o. male with past medical history of alcoholic cirrhosis complicated by hepatic encephalopathy who was transferred to ED from outside hospital on 07/23/22 with chief complaint of bleeding from venipuncture site and toe after trimming his nails. Patient was recently admitted for pneumonia and sepsis with a COVID positive test on 7/03 s/p monoclonal antibodies. During this visit, patient was diagnosed with bilateral pleural effusions and MRI showing psoas abscess and liver cysts. He was discharged on 07/21 with a 12 day course of ceftin and Flagyl. On 07/23, presented due to uncontrolled bleeding from his venipuncture site and toe where he was found to be thrombocytopenic with elevated coagulation parameters. Platelet infusion was started but was not completed due to patient becoming short of breath with associated edema requiring Lasix. Patient was transferred here for further management. CXR showed right perihilar opacity which may reflect pneumonia and trace left effusion. MRI showed likely psoas muscle hematoma, indeterminate medial left lobe lesion worrisome for malignancy, indeterminate anterior right lobe lesion, cirrhosis with findings of portal hypertension, splenomegaly, moderate caliber varices with patent portal vein, cholelithiasis with diffuse gallbladder wall thickening, and small pleural effusions with lung base atelectasis. US abdomen with similar findings. Repeat MRI characterized liver lesions as hemangiomas.  He was found to have significantly elevated INR with bleeding from venipuncture sites.  Patient was given 3 days 10 g vitamin K.  His INR continually decreased day by day and venipuncture bleeding ceased.  Respiratory atypical bacteria panel, legionella, and strep pneumoniae antigens were negative. Hepatology was consulted - patient does not meet criteria for further evaluation for liver transplant at this time. This was discussed by hepatology  team with the patient. We enquired hepatology about the EGD for variceal banding who recommended that it can be done as outpatient since there is no suspicion of active bleed. Also recommended that antibiotics prophylaxis was not indicated. Prior to discharge, we discussed this all with the patient. Patient was discharged in stable condition and instructed to follow-up with the specialists and PCP. All questions were answered.
Age: 32.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Thrombocytopenia, Ultrasound abdomen abnormal, Vessel puncture site haemorrhage
Clinical narrative: 7/23--7/27 33 y.o. male with past medical history of alcoholic cirrhosis complicated by hepatic encephalopathy who was transferred to ED from outside hospital on 07/23/22 with chief complaint of bleeding from venipuncture site and toe after trimming his nails. Patient was recently admitted for pneumonia and sepsis with a COVID positive test on 7/03 s/p monoclonal antibodies. During this visit, patient was diagnosed with bilateral pleural effusions and MRI showing psoas abscess and liver cysts. He was discharged on 07/21 with a 12 day course of ceftin and Flagyl. On 07/23, presented due to uncontrolled bleeding from his venipuncture site and toe where he was found to be thrombocytopenic with elevated coagulation parameters. Platelet infusion was started but was not completed due to patient becoming short of breath with associated edema requiring Lasix. Patient was transferred here for further management. CXR showed right perihilar opacity which may reflect pneumonia and trace left effusion. MRI showed likely psoas muscle hematoma, indeterminate medial left lobe lesion worrisome for malignancy, indeterminate anterior right lobe lesion, cirrhosis with findings of portal hypertension, splenomegaly, moderate caliber varices with patent portal vein, cholelithiasis with diffuse gallbladder wall thickening, and small pleural effusions with lung base atelectasis. US abdomen with similar findings. Repeat MRI characterized liver lesions as hemangiomas.  He was found to have significantly elevated INR with bleeding from venipuncture sites.  Patient was given 3 days 10 g vitamin K.  His INR continually decreased day by day and venipuncture bleeding ceased.  Respiratory atypical bacteria panel, legionella, and strep pneumoniae antigens were negative. Hepatology was consulted - patient does not meet criteria for further evaluation for liver transplant at this time. This was discussed by hepatology  team with the patient. We enquired hepatology about the EGD for variceal banding who recommended that it can be done as outpatient since there is no suspicion of active bleed. Also recommended that antibiotics prophylaxis was not indicated. Prior to discharge, we discussed this all with the patient. Patient was discharged in stable condition and instructed to follow-up with the specialists and PCP. All questions were answered.
Age: 41.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Caesarean section, Delivery, Haemorrhage, Maternal exposure before pregnancy
Clinical narrative: 7/20 - 7/22: 43-year-old G4P1021 at 37w4d presenting to triage for scheduled repeat C-section (elective). 7/20 delivered baby. Seen and evaluated 7/22. Patient examined and note addended as indicated. Doing well POD 2. Pain controlled, tolerating PO, ambulating, bleeding minimal. Recovering from COVID-19. Tested positive last week. Stable for d/c home. Follow-up 2 weeks.
Age: 41.0
Sex: F
Vaccine: COVID19
Symptoms: Pain, SARS-CoV-2 test positive
Clinical narrative: 7/20 - 7/22: 43-year-old G4P1021 at 37w4d presenting to triage for scheduled repeat C-section (elective). 7/20 delivered baby. Seen and evaluated 7/22. Patient examined and note addended as indicated. Doing well POD 2. Pain controlled, tolerating PO, ambulating, bleeding minimal. Recovering from COVID-19. Tested positive last week. Stable for d/c home. Follow-up 2 weeks.
Age: 40.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: COVID-19, COVID-19 pneumonia, Condition aggravated, Dyspnoea, Fatigue
Clinical narrative: 7/20--7/26 Pt is a very pleasant 41 yo AAM PMHx HTN, obesity, CHF, OSA, presenting to the EC as a transfer for COVID pneumonia and hypoxia. Pt went to EC for fatigue and SOB. He was found to have significant HTN and SOB with O2 sats at 83%. He was transferred here for further work-up. Pt was given decadron and lasix in tandem with supplemental O2. He has been enjoying his usual health before getting COVID. He is vaccinated x 2. Was seen by ID and placed on remdesivir and dexamethasone. Eventually hypoxia resolved and patient was able to ambulate well without desaturation. Completed courses of remdesivir and dexamethasone inpatient. Discharged with instructions to follow up with primary care.
Age: 40.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Hypertension, Hypoxia, SARS-CoV-2 test positive
Clinical narrative: 7/20--7/26 Pt is a very pleasant 41 yo AAM PMHx HTN, obesity, CHF, OSA, presenting to the EC as a transfer for COVID pneumonia and hypoxia. Pt went to EC for fatigue and SOB. He was found to have significant HTN and SOB with O2 sats at 83%. He was transferred here for further work-up. Pt was given decadron and lasix in tandem with supplemental O2. He has been enjoying his usual health before getting COVID. He is vaccinated x 2. Was seen by ID and placed on remdesivir and dexamethasone. Eventually hypoxia resolved and patient was able to ambulate well without desaturation. Completed courses of remdesivir and dexamethasone inpatient. Discharged with instructions to follow up with primary care.
Age: 47.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Angiogram pulmonary normal, Arteriogram coronary normal, Arthralgia, Back pain, COVID-19
Clinical narrative: 7/31--8/3 48-year-old male with past medical history significant for COPD and newly diagnosed right sided adenocarcinoma of the lung.  He presented on 7/31/2022 for complaint of chest pain.  He initially presented to Facility on 7/30 for the same complaint and his EKG revealed ST elevation in leads II, III and aVF as well as V4 through V6.  He was transferred here to Facility for higher level of care.  He was taken to the Cath Lab emergently, but the angiogram revealed normal coronaries.  He was also found to be COVID-positive. This is a new infection as he had a recent negative COVID test on 7/2/2022.  Of note he was recently discharged from Facility after a long hospital stay from 7/6 until 7/19 for an acute SVC syndrome secondary to his lung carcinoma.  At that time he was treated with chemotherapy and a few bouts of radiation with resolution of his symptoms.  Given his COVID-positive status and the recent radiation, his chest pain was considered to be an acute pericarditis.  He was requiring 2 L nasal cannula of oxygen during his stay, thus he was started on Decadron 6 mg daily to treat his COVID as well as treating his pericarditis until discharge. He was also started on Remdesivir 100mg IV once daily on 7/31 and Robitussin by ID for COVID. 7/31 he was no longer needing supplemental oxygen, saturating well on room air. Troponin wnl. CTA PE on 7/31 was negative for PE and 2D echo on 8/1 had no pericardial effusion visualized but was limited as patient could not turn; L ventricle normal size with EF 55% and R ventricle moderately decreased. During admission, WBC was up-trending, and he continued to have unchanged R back and R shoulder pain, some relief with leaning forward. IV morphine for breakthrough pain started on 8/1 was switched to Percocet on 8/2 every 6 hours for longer pain relief. Chest pain improved over the 3 day stay and he regained his appetite and was able to eat full meals starting 8/2. His constipation improved as well and he did not need bowel regiment on 8/2. He continued to have sputum production once a day with relief of SOB after coughing out sputum. He was continued on abluterol and breo during his stay. Hemeonc withheld chemo and radiation in the context of his current COVID + status.  Prior to discharge, cardiology recommended discontinuing Decadron and beginning colchicine 0.6mg daily (weight adjusted) until followup with them in outpatient clinic.  Patient has been saturating well on room air for over 3 days and he is stable for discharge home.
Age: 47.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Chemotherapy, Chest pain, Constipation, Decreased appetite, Dyspnoea
Clinical narrative: 7/31--8/3 48-year-old male with past medical history significant for COPD and newly diagnosed right sided adenocarcinoma of the lung.  He presented on 7/31/2022 for complaint of chest pain.  He initially presented to Facility on 7/30 for the same complaint and his EKG revealed ST elevation in leads II, III and aVF as well as V4 through V6.  He was transferred here to Facility for higher level of care.  He was taken to the Cath Lab emergently, but the angiogram revealed normal coronaries.  He was also found to be COVID-positive. This is a new infection as he had a recent negative COVID test on 7/2/2022.  Of note he was recently discharged from Facility after a long hospital stay from 7/6 until 7/19 for an acute SVC syndrome secondary to his lung carcinoma.  At that time he was treated with chemotherapy and a few bouts of radiation with resolution of his symptoms.  Given his COVID-positive status and the recent radiation, his chest pain was considered to be an acute pericarditis.  He was requiring 2 L nasal cannula of oxygen during his stay, thus he was started on Decadron 6 mg daily to treat his COVID as well as treating his pericarditis until discharge. He was also started on Remdesivir 100mg IV once daily on 7/31 and Robitussin by ID for COVID. 7/31 he was no longer needing supplemental oxygen, saturating well on room air. Troponin wnl. CTA PE on 7/31 was negative for PE and 2D echo on 8/1 had no pericardial effusion visualized but was limited as patient could not turn; L ventricle normal size with EF 55% and R ventricle moderately decreased. During admission, WBC was up-trending, and he continued to have unchanged R back and R shoulder pain, some relief with leaning forward. IV morphine for breakthrough pain started on 8/1 was switched to Percocet on 8/2 every 6 hours for longer pain relief. Chest pain improved over the 3 day stay and he regained his appetite and was able to eat full meals starting 8/2. His constipation improved as well and he did not need bowel regiment on 8/2. He continued to have sputum production once a day with relief of SOB after coughing out sputum. He was continued on abluterol and breo during his stay. Hemeonc withheld chemo and radiation in the context of his current COVID + status.  Prior to discharge, cardiology recommended discontinuing Decadron and beginning colchicine 0.6mg daily (weight adjusted) until followup with them in outpatient clinic.  Patient has been saturating well on room air for over 3 days and he is stable for discharge home.
Age: 47.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Echocardiogram normal, Electrocardiogram ST segment elevation, Lung adenocarcinoma, Pericarditis, Productive cough
Clinical narrative: 7/31--8/3 48-year-old male with past medical history significant for COPD and newly diagnosed right sided adenocarcinoma of the lung.  He presented on 7/31/2022 for complaint of chest pain.  He initially presented to Facility on 7/30 for the same complaint and his EKG revealed ST elevation in leads II, III and aVF as well as V4 through V6.  He was transferred here to Facility for higher level of care.  He was taken to the Cath Lab emergently, but the angiogram revealed normal coronaries.  He was also found to be COVID-positive. This is a new infection as he had a recent negative COVID test on 7/2/2022.  Of note he was recently discharged from Facility after a long hospital stay from 7/6 until 7/19 for an acute SVC syndrome secondary to his lung carcinoma.  At that time he was treated with chemotherapy and a few bouts of radiation with resolution of his symptoms.  Given his COVID-positive status and the recent radiation, his chest pain was considered to be an acute pericarditis.  He was requiring 2 L nasal cannula of oxygen during his stay, thus he was started on Decadron 6 mg daily to treat his COVID as well as treating his pericarditis until discharge. He was also started on Remdesivir 100mg IV once daily on 7/31 and Robitussin by ID for COVID. 7/31 he was no longer needing supplemental oxygen, saturating well on room air. Troponin wnl. CTA PE on 7/31 was negative for PE and 2D echo on 8/1 had no pericardial effusion visualized but was limited as patient could not turn; L ventricle normal size with EF 55% and R ventricle moderately decreased. During admission, WBC was up-trending, and he continued to have unchanged R back and R shoulder pain, some relief with leaning forward. IV morphine for breakthrough pain started on 8/1 was switched to Percocet on 8/2 every 6 hours for longer pain relief. Chest pain improved over the 3 day stay and he regained his appetite and was able to eat full meals starting 8/2. His constipation improved as well and he did not need bowel regiment on 8/2. He continued to have sputum production once a day with relief of SOB after coughing out sputum. He was continued on abluterol and breo during his stay. Hemeonc withheld chemo and radiation in the context of his current COVID + status.  Prior to discharge, cardiology recommended discontinuing Decadron and beginning colchicine 0.6mg daily (weight adjusted) until followup with them in outpatient clinic.  Patient has been saturating well on room air for over 3 days and he is stable for discharge home.
Age: 47.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Radiotherapy, Right ventricular ejection fraction decreased, SARS-CoV-2 test positive, Superior vena cava syndrome, Troponin normal
Clinical narrative: 7/31--8/3 48-year-old male with past medical history significant for COPD and newly diagnosed right sided adenocarcinoma of the lung.  He presented on 7/31/2022 for complaint of chest pain.  He initially presented to Facility on 7/30 for the same complaint and his EKG revealed ST elevation in leads II, III and aVF as well as V4 through V6.  He was transferred here to Facility for higher level of care.  He was taken to the Cath Lab emergently, but the angiogram revealed normal coronaries.  He was also found to be COVID-positive. This is a new infection as he had a recent negative COVID test on 7/2/2022.  Of note he was recently discharged from Facility after a long hospital stay from 7/6 until 7/19 for an acute SVC syndrome secondary to his lung carcinoma.  At that time he was treated with chemotherapy and a few bouts of radiation with resolution of his symptoms.  Given his COVID-positive status and the recent radiation, his chest pain was considered to be an acute pericarditis.  He was requiring 2 L nasal cannula of oxygen during his stay, thus he was started on Decadron 6 mg daily to treat his COVID as well as treating his pericarditis until discharge. He was also started on Remdesivir 100mg IV once daily on 7/31 and Robitussin by ID for COVID. 7/31 he was no longer needing supplemental oxygen, saturating well on room air. Troponin wnl. CTA PE on 7/31 was negative for PE and 2D echo on 8/1 had no pericardial effusion visualized but was limited as patient could not turn; L ventricle normal size with EF 55% and R ventricle moderately decreased. During admission, WBC was up-trending, and he continued to have unchanged R back and R shoulder pain, some relief with leaning forward. IV morphine for breakthrough pain started on 8/1 was switched to Percocet on 8/2 every 6 hours for longer pain relief. Chest pain improved over the 3 day stay and he regained his appetite and was able to eat full meals starting 8/2. His constipation improved as well and he did not need bowel regiment on 8/2. He continued to have sputum production once a day with relief of SOB after coughing out sputum. He was continued on abluterol and breo during his stay. Hemeonc withheld chemo and radiation in the context of his current COVID + status.  Prior to discharge, cardiology recommended discontinuing Decadron and beginning colchicine 0.6mg daily (weight adjusted) until followup with them in outpatient clinic.  Patient has been saturating well on room air for over 3 days and he is stable for discharge home.
Age: 47.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Ventricular fibrillation, White blood cell count
Clinical narrative: 7/31--8/3 48-year-old male with past medical history significant for COPD and newly diagnosed right sided adenocarcinoma of the lung.  He presented on 7/31/2022 for complaint of chest pain.  He initially presented to Facility on 7/30 for the same complaint and his EKG revealed ST elevation in leads II, III and aVF as well as V4 through V6.  He was transferred here to Facility for higher level of care.  He was taken to the Cath Lab emergently, but the angiogram revealed normal coronaries.  He was also found to be COVID-positive. This is a new infection as he had a recent negative COVID test on 7/2/2022.  Of note he was recently discharged from Facility after a long hospital stay from 7/6 until 7/19 for an acute SVC syndrome secondary to his lung carcinoma.  At that time he was treated with chemotherapy and a few bouts of radiation with resolution of his symptoms.  Given his COVID-positive status and the recent radiation, his chest pain was considered to be an acute pericarditis.  He was requiring 2 L nasal cannula of oxygen during his stay, thus he was started on Decadron 6 mg daily to treat his COVID as well as treating his pericarditis until discharge. He was also started on Remdesivir 100mg IV once daily on 7/31 and Robitussin by ID for COVID. 7/31 he was no longer needing supplemental oxygen, saturating well on room air. Troponin wnl. CTA PE on 7/31 was negative for PE and 2D echo on 8/1 had no pericardial effusion visualized but was limited as patient could not turn; L ventricle normal size with EF 55% and R ventricle moderately decreased. During admission, WBC was up-trending, and he continued to have unchanged R back and R shoulder pain, some relief with leaning forward. IV morphine for breakthrough pain started on 8/1 was switched to Percocet on 8/2 every 6 hours for longer pain relief. Chest pain improved over the 3 day stay and he regained his appetite and was able to eat full meals starting 8/2. His constipation improved as well and he did not need bowel regiment on 8/2. He continued to have sputum production once a day with relief of SOB after coughing out sputum. He was continued on abluterol and breo during his stay. Hemeonc withheld chemo and radiation in the context of his current COVID + status.  Prior to discharge, cardiology recommended discontinuing Decadron and beginning colchicine 0.6mg daily (weight adjusted) until followup with them in outpatient clinic.  Patient has been saturating well on room air for over 3 days and he is stable for discharge home.
Age: 55.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Acute respiratory failure, Ascites, Blood creatinine increased, Blood magnesium decreased, Blood sodium decreased
Clinical narrative: 7/20--8/2 57-year-old male, presented from Hospital with hypotension and shortness of breath. He entered Hospital for a "liver workup" and paracentesis. When he got hypotensive, he was transferred to facility. He also had 9000 cc ascitic fluid removed initially. He is COVID positive and is partially vaccinated. He is an ex-cigarette smoker with multiple comorbidities. His hemoglobin and sodium were low as was his CO2 and magnesium. His creatinine was elevated. The patient was treated initially with his usual medications including intravenous fluids, electrolytes, and he was started on Flagyl and vancomycin as well as Levophed for an initial low blood pressure.  His low magnesium was replaced and he had  positive MRSA in his nasal swab and was started on mupirocin.  At this time, COVID isolation was removed.  On 07/23, there was evidence of acute hypoxic respiratory failure and fluid overload.  Hypotension with possible sepsis from urinary tract infection was noted.  It is obvious he had decompensated cirrhosis with ascites and later required a second paracentesis.  His hemoglobin initially dropped.  He had evidence of bilateral pulmonary edema with a rising BNP and MRSA was in the respiratory culture.  He was continued on Flagyl and Vancomycin, and electrolytes were replaced as needed.  INR was as high as 2.9 and again, magnesium was low and had to be replaced.  BNP went up to 836 and metabolic acidosis was noted as well as portal hypertension earlier, requiring Blakemore tube.  Creatinine started to rise.  Metabolic acidosis was present and he continued to deteriorate and hospice was inquired.  His mentation was very poor and there was a question of anisocoria.  A CT of the head was ordered, but he continued to deteriorate and on 08/01/2022, he was discharged to inpatient hospice. Upon hourly rounding  patient assessed and unresponsive to verbal and tactile stimuli, pulseless, respirations and heartsounds absent.  Pupils dilated, fixed, and unresponsive to light.  Date and time of death pronounced on  8/2/22 at 0545.