chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Computerised tomogram normal, Glycosylated haemoglobin, Goitre, Hepatic lesion, Hydronephrosis
Clinical narrative: Patient is a 69 y.o. female patient of MD residing in extended care facility with history of hypertension hyperlipidemia diabetes mellitus, and is known for bipolar depressive disorder also anemia of iron deficiency and Parkinson's disease is here due to alteration mental status and reported COVID-positive noted to be borderline hypoxic at 88% at room air was admitted for further management CAT scan of the brain showed no acute findings and chest x-ray on arrival was negative for any infiltrates, poor historian on arrival to the emergency department    COVID-19 respiratory infection Acute hypoxic respiratory failure Overall stable vital signs requiring oxygen by nasal cannula  Chest x-ray reviewed showed no infiltrates CTPA reviewed with no pulmonary emboli.  Showed bilateral lung infiltrates versus atelectasis.  Also, some groundglass opacities and consolidative opacities. Check on inflammatory markers.  CRP 123 on presentation ID consult.  ID has been following.  Patient was treated with steroids and remdesivir during hospitalization.  Will continue oral steroids on discharge   Colon cancer with liver metastasis POA  CTPA showed multiple new liver lesions concerning for metastatic disease.  CT abdomen pelvis showed 6 cm sigmoid colon mass with moderate to significant narrowing of the sigmoid lumen.  There is proximal dilation of the large bowel with moderate amount of stool. CTA 1,179 Last colonoscopy 11-2019 large polyp removed from ascending colon at facility, resulted in perforated colon for which she underwent right hemicolectomy with primary anastomosis with Dr.  The  pathology of the polyp is not available to us at this time. Discussed the findings with the Guardian. She is the patient's daughter. Consulted general surgery and oncology.  General surgery evaluated patient.  The patient will need colonoscopy.  This should be done in the near future given that she has an acute infection with COVID.  Surgery signed off.     IR consulted for liver biopsy.  IR decided to do the procedure after recovery from COVID as outpatient.  This will need to be followed up Per heme-onc, workup to be done as outpatient, will need close follow-up for this.  Discussed with case management on day of discharge for helping expedite this and setting up appointment   Acute metabolic encephalopathy POA improved Likely related to the infection, CAT scan of the brain reviewed and showed no acute findings Neurochecks   Right hydronephrosis CT PE showed increasing right hydronephrosis Kidney functions within normal Outpatient follow-up Hypertension Continue lisinopril and metoprolol   Diabetes mellitus  Lantus at lower dose while in hospital. Was on 38 units started recently at SNF. Sliding scale insulin, Januvia, and metformin Hold glipizide Hemoglobin A1c 7.4   Hyperlipidemia  on statin therapy   Pulmonary nodule 6 mm nodule in the left upper lobe Outpatient follow-up   Goiter CTPA showed heterogenous nodular thyroid which may reflect goiter TSH within normal Outpatient follow-up
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Hypoxia, Intestinal dilatation, Intestinal mass, Laboratory test, Lung consolidation
Clinical narrative: Patient is a 69 y.o. female patient of MD residing in extended care facility with history of hypertension hyperlipidemia diabetes mellitus, and is known for bipolar depressive disorder also anemia of iron deficiency and Parkinson's disease is here due to alteration mental status and reported COVID-positive noted to be borderline hypoxic at 88% at room air was admitted for further management CAT scan of the brain showed no acute findings and chest x-ray on arrival was negative for any infiltrates, poor historian on arrival to the emergency department    COVID-19 respiratory infection Acute hypoxic respiratory failure Overall stable vital signs requiring oxygen by nasal cannula  Chest x-ray reviewed showed no infiltrates CTPA reviewed with no pulmonary emboli.  Showed bilateral lung infiltrates versus atelectasis.  Also, some groundglass opacities and consolidative opacities. Check on inflammatory markers.  CRP 123 on presentation ID consult.  ID has been following.  Patient was treated with steroids and remdesivir during hospitalization.  Will continue oral steroids on discharge   Colon cancer with liver metastasis POA  CTPA showed multiple new liver lesions concerning for metastatic disease.  CT abdomen pelvis showed 6 cm sigmoid colon mass with moderate to significant narrowing of the sigmoid lumen.  There is proximal dilation of the large bowel with moderate amount of stool. CTA 1,179 Last colonoscopy 11-2019 large polyp removed from ascending colon at facility, resulted in perforated colon for which she underwent right hemicolectomy with primary anastomosis with Dr.  The  pathology of the polyp is not available to us at this time. Discussed the findings with the Guardian. She is the patient's daughter. Consulted general surgery and oncology.  General surgery evaluated patient.  The patient will need colonoscopy.  This should be done in the near future given that she has an acute infection with COVID.  Surgery signed off.     IR consulted for liver biopsy.  IR decided to do the procedure after recovery from COVID as outpatient.  This will need to be followed up Per heme-onc, workup to be done as outpatient, will need close follow-up for this.  Discussed with case management on day of discharge for helping expedite this and setting up appointment   Acute metabolic encephalopathy POA improved Likely related to the infection, CAT scan of the brain reviewed and showed no acute findings Neurochecks   Right hydronephrosis CT PE showed increasing right hydronephrosis Kidney functions within normal Outpatient follow-up Hypertension Continue lisinopril and metoprolol   Diabetes mellitus  Lantus at lower dose while in hospital. Was on 38 units started recently at SNF. Sliding scale insulin, Januvia, and metformin Hold glipizide Hemoglobin A1c 7.4   Hyperlipidemia  on statin therapy   Pulmonary nodule 6 mm nodule in the left upper lobe Outpatient follow-up   Goiter CTPA showed heterogenous nodular thyroid which may reflect goiter TSH within normal Outpatient follow-up
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Lung infiltration, Lung opacity, Mental status changes, Metabolic encephalopathy, Metastases to liver
Clinical narrative: Patient is a 69 y.o. female patient of MD residing in extended care facility with history of hypertension hyperlipidemia diabetes mellitus, and is known for bipolar depressive disorder also anemia of iron deficiency and Parkinson's disease is here due to alteration mental status and reported COVID-positive noted to be borderline hypoxic at 88% at room air was admitted for further management CAT scan of the brain showed no acute findings and chest x-ray on arrival was negative for any infiltrates, poor historian on arrival to the emergency department    COVID-19 respiratory infection Acute hypoxic respiratory failure Overall stable vital signs requiring oxygen by nasal cannula  Chest x-ray reviewed showed no infiltrates CTPA reviewed with no pulmonary emboli.  Showed bilateral lung infiltrates versus atelectasis.  Also, some groundglass opacities and consolidative opacities. Check on inflammatory markers.  CRP 123 on presentation ID consult.  ID has been following.  Patient was treated with steroids and remdesivir during hospitalization.  Will continue oral steroids on discharge   Colon cancer with liver metastasis POA  CTPA showed multiple new liver lesions concerning for metastatic disease.  CT abdomen pelvis showed 6 cm sigmoid colon mass with moderate to significant narrowing of the sigmoid lumen.  There is proximal dilation of the large bowel with moderate amount of stool. CTA 1,179 Last colonoscopy 11-2019 large polyp removed from ascending colon at facility, resulted in perforated colon for which she underwent right hemicolectomy with primary anastomosis with Dr.  The  pathology of the polyp is not available to us at this time. Discussed the findings with the Guardian. She is the patient's daughter. Consulted general surgery and oncology.  General surgery evaluated patient.  The patient will need colonoscopy.  This should be done in the near future given that she has an acute infection with COVID.  Surgery signed off.     IR consulted for liver biopsy.  IR decided to do the procedure after recovery from COVID as outpatient.  This will need to be followed up Per heme-onc, workup to be done as outpatient, will need close follow-up for this.  Discussed with case management on day of discharge for helping expedite this and setting up appointment   Acute metabolic encephalopathy POA improved Likely related to the infection, CAT scan of the brain reviewed and showed no acute findings Neurochecks   Right hydronephrosis CT PE showed increasing right hydronephrosis Kidney functions within normal Outpatient follow-up Hypertension Continue lisinopril and metoprolol   Diabetes mellitus  Lantus at lower dose while in hospital. Was on 38 units started recently at SNF. Sliding scale insulin, Januvia, and metformin Hold glipizide Hemoglobin A1c 7.4   Hyperlipidemia  on statin therapy   Pulmonary nodule 6 mm nodule in the left upper lobe Outpatient follow-up   Goiter CTPA showed heterogenous nodular thyroid which may reflect goiter TSH within normal Outpatient follow-up
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Pulmonary mass, Renal function test normal, SARS-CoV-2 test positive, Thyroid mass
Clinical narrative: Patient is a 69 y.o. female patient of MD residing in extended care facility with history of hypertension hyperlipidemia diabetes mellitus, and is known for bipolar depressive disorder also anemia of iron deficiency and Parkinson's disease is here due to alteration mental status and reported COVID-positive noted to be borderline hypoxic at 88% at room air was admitted for further management CAT scan of the brain showed no acute findings and chest x-ray on arrival was negative for any infiltrates, poor historian on arrival to the emergency department    COVID-19 respiratory infection Acute hypoxic respiratory failure Overall stable vital signs requiring oxygen by nasal cannula  Chest x-ray reviewed showed no infiltrates CTPA reviewed with no pulmonary emboli.  Showed bilateral lung infiltrates versus atelectasis.  Also, some groundglass opacities and consolidative opacities. Check on inflammatory markers.  CRP 123 on presentation ID consult.  ID has been following.  Patient was treated with steroids and remdesivir during hospitalization.  Will continue oral steroids on discharge   Colon cancer with liver metastasis POA  CTPA showed multiple new liver lesions concerning for metastatic disease.  CT abdomen pelvis showed 6 cm sigmoid colon mass with moderate to significant narrowing of the sigmoid lumen.  There is proximal dilation of the large bowel with moderate amount of stool. CTA 1,179 Last colonoscopy 11-2019 large polyp removed from ascending colon at facility, resulted in perforated colon for which she underwent right hemicolectomy with primary anastomosis with Dr.  The  pathology of the polyp is not available to us at this time. Discussed the findings with the Guardian. She is the patient's daughter. Consulted general surgery and oncology.  General surgery evaluated patient.  The patient will need colonoscopy.  This should be done in the near future given that she has an acute infection with COVID.  Surgery signed off.     IR consulted for liver biopsy.  IR decided to do the procedure after recovery from COVID as outpatient.  This will need to be followed up Per heme-onc, workup to be done as outpatient, will need close follow-up for this.  Discussed with case management on day of discharge for helping expedite this and setting up appointment   Acute metabolic encephalopathy POA improved Likely related to the infection, CAT scan of the brain reviewed and showed no acute findings Neurochecks   Right hydronephrosis CT PE showed increasing right hydronephrosis Kidney functions within normal Outpatient follow-up Hypertension Continue lisinopril and metoprolol   Diabetes mellitus  Lantus at lower dose while in hospital. Was on 38 units started recently at SNF. Sliding scale insulin, Januvia, and metformin Hold glipizide Hemoglobin A1c 7.4   Hyperlipidemia  on statin therapy   Pulmonary nodule 6 mm nodule in the left upper lobe Outpatient follow-up   Goiter CTPA showed heterogenous nodular thyroid which may reflect goiter TSH within normal Outpatient follow-up
Age: 38.0
Sex: F
Vaccine: COVID19, FLU4
Symptoms: Muscle spasms, Restless legs syndrome
Clinical narrative: Restless legs and muscle spasms started approximately 8 hours after injection, continued for another 8 hours. I?ve never had any adverse effects before. I?ve always had Pfiser and this time I received Moderna.
Age: 54.0
Sex: M
Vaccine: COVID19
Symptoms: Eye pain, Ocular discomfort, Ocular hyperaemia
Clinical narrative: I had severe redness in eyes with pain that started 3 days after the covid vaccine. I was originally prescribed by optometrist (non-facility provider) on 12/23 FML 0.1% drops 1 drop 3x daily x 7 days, then daily x 7 days. Due to severe pain, I saw a facility doctor 1/24 and was given tramadol for pain and told to use FML as previously prescribed. The redness and pain persisted so I opted to see a facility optometrist on 12/26 and was prescribed neo/poly/dex ointment 2-3x daily for 10 days and Prednisolone acetate one drop 4x daily x 7 days. I am noticing improvement. I am using a lubricant eye ointment for the continued discomfort.
Age: 68.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Asthenia, Atelectasis, Back pain
Clinical narrative: Patient is a 70 y.o. female patient of MD with history of IDDM2, HTN, HLD, CHFrEF, chronic pain syndrome, DVT, who presented to Hospital with weakness.   UTI: Cefazolin Urine culture with E coli sensitive to cefazolin Will give keflex on discharge   Covid-19 Virus Infection Acute hypoxemic respiratory failure: Date of onset of symptoms: 11/19/23 Symptoms present on admission: Dizziness, weakness Date of covid positive test: 11/19/23 Vaccination status: vaccinated Imaging: CXR with mild bibasilar atelectasis vs airspace disease Oxygen requirements on admission: 2 Lpm by NC Current oxygen requirements: 2 Lpm by NC Medical therapy: steroids; remdesivir started by ID Consultants following: ID Anticipated special isolation end date: 11/30/2023   AKI on chronic kidney disease: Hyperkalemia: Creatinine baseline approximately 1.4  Creatinine on admission was 2.17   Hold lasix and Entresto IVFs Back to baseline on 11/22   Generalized weakness Fall  Acute on chronic back pain PT/OT Care management Fall precautions Thoracic lumbar and cervical x-rays-shows some severe degenerative ds Pt has seen Dr in past, will follow up with him as OP   Chronic CHFrEF: HTN: Hold Lasix and Entresto  elevated BNP to 2900 after fluids Toprol Stop IV fluids on 11/20   DVT: Warfarin per pharmacy   HLD: Atovastatin   Chronic pain syndrome: Continue home Butrans patch   GERD: PPI   IDDM2: Hold glipizide and metformin due to AKI Lantus and SSI
Age: 68.0
Sex: F
Vaccine: COVID19
Symptoms: Blood creatinine increased, Brain natriuretic peptide increased, COVID-19, Chest X-ray abnormal, Chronic kidney disease
Clinical narrative: Patient is a 70 y.o. female patient of MD with history of IDDM2, HTN, HLD, CHFrEF, chronic pain syndrome, DVT, who presented to Hospital with weakness.   UTI: Cefazolin Urine culture with E coli sensitive to cefazolin Will give keflex on discharge   Covid-19 Virus Infection Acute hypoxemic respiratory failure: Date of onset of symptoms: 11/19/23 Symptoms present on admission: Dizziness, weakness Date of covid positive test: 11/19/23 Vaccination status: vaccinated Imaging: CXR with mild bibasilar atelectasis vs airspace disease Oxygen requirements on admission: 2 Lpm by NC Current oxygen requirements: 2 Lpm by NC Medical therapy: steroids; remdesivir started by ID Consultants following: ID Anticipated special isolation end date: 11/30/2023   AKI on chronic kidney disease: Hyperkalemia: Creatinine baseline approximately 1.4  Creatinine on admission was 2.17   Hold lasix and Entresto IVFs Back to baseline on 11/22   Generalized weakness Fall  Acute on chronic back pain PT/OT Care management Fall precautions Thoracic lumbar and cervical x-rays-shows some severe degenerative ds Pt has seen Dr in past, will follow up with him as OP   Chronic CHFrEF: HTN: Hold Lasix and Entresto  elevated BNP to 2900 after fluids Toprol Stop IV fluids on 11/20   DVT: Warfarin per pharmacy   HLD: Atovastatin   Chronic pain syndrome: Continue home Butrans patch   GERD: PPI   IDDM2: Hold glipizide and metformin due to AKI Lantus and SSI
Age: 68.0
Sex: F
Vaccine: COVID19
Symptoms: Deep vein thrombosis, Dizziness, Escherichia test positive, Fall, Gastrooesophageal reflux disease
Clinical narrative: Patient is a 70 y.o. female patient of MD with history of IDDM2, HTN, HLD, CHFrEF, chronic pain syndrome, DVT, who presented to Hospital with weakness.   UTI: Cefazolin Urine culture with E coli sensitive to cefazolin Will give keflex on discharge   Covid-19 Virus Infection Acute hypoxemic respiratory failure: Date of onset of symptoms: 11/19/23 Symptoms present on admission: Dizziness, weakness Date of covid positive test: 11/19/23 Vaccination status: vaccinated Imaging: CXR with mild bibasilar atelectasis vs airspace disease Oxygen requirements on admission: 2 Lpm by NC Current oxygen requirements: 2 Lpm by NC Medical therapy: steroids; remdesivir started by ID Consultants following: ID Anticipated special isolation end date: 11/30/2023   AKI on chronic kidney disease: Hyperkalemia: Creatinine baseline approximately 1.4  Creatinine on admission was 2.17   Hold lasix and Entresto IVFs Back to baseline on 11/22   Generalized weakness Fall  Acute on chronic back pain PT/OT Care management Fall precautions Thoracic lumbar and cervical x-rays-shows some severe degenerative ds Pt has seen Dr in past, will follow up with him as OP   Chronic CHFrEF: HTN: Hold Lasix and Entresto  elevated BNP to 2900 after fluids Toprol Stop IV fluids on 11/20   DVT: Warfarin per pharmacy   HLD: Atovastatin   Chronic pain syndrome: Continue home Butrans patch   GERD: PPI   IDDM2: Hold glipizide and metformin due to AKI Lantus and SSI
Age: 68.0
Sex: F
Vaccine: COVID19
Symptoms: Hyperkalaemia, Hyperlipidaemia, Lung disorder, SARS-CoV-2 test positive, Spinal X-ray abnormal
Clinical narrative: Patient is a 70 y.o. female patient of MD with history of IDDM2, HTN, HLD, CHFrEF, chronic pain syndrome, DVT, who presented to Hospital with weakness.   UTI: Cefazolin Urine culture with E coli sensitive to cefazolin Will give keflex on discharge   Covid-19 Virus Infection Acute hypoxemic respiratory failure: Date of onset of symptoms: 11/19/23 Symptoms present on admission: Dizziness, weakness Date of covid positive test: 11/19/23 Vaccination status: vaccinated Imaging: CXR with mild bibasilar atelectasis vs airspace disease Oxygen requirements on admission: 2 Lpm by NC Current oxygen requirements: 2 Lpm by NC Medical therapy: steroids; remdesivir started by ID Consultants following: ID Anticipated special isolation end date: 11/30/2023   AKI on chronic kidney disease: Hyperkalemia: Creatinine baseline approximately 1.4  Creatinine on admission was 2.17   Hold lasix and Entresto IVFs Back to baseline on 11/22   Generalized weakness Fall  Acute on chronic back pain PT/OT Care management Fall precautions Thoracic lumbar and cervical x-rays-shows some severe degenerative ds Pt has seen Dr in past, will follow up with him as OP   Chronic CHFrEF: HTN: Hold Lasix and Entresto  elevated BNP to 2900 after fluids Toprol Stop IV fluids on 11/20   DVT: Warfarin per pharmacy   HLD: Atovastatin   Chronic pain syndrome: Continue home Butrans patch   GERD: PPI   IDDM2: Hold glipizide and metformin due to AKI Lantus and SSI
Age: 68.0
Sex: F
Vaccine: COVID19
Symptoms: Spinal osteoarthritis, Urinary tract infection
Clinical narrative: Patient is a 70 y.o. female patient of MD with history of IDDM2, HTN, HLD, CHFrEF, chronic pain syndrome, DVT, who presented to Hospital with weakness.   UTI: Cefazolin Urine culture with E coli sensitive to cefazolin Will give keflex on discharge   Covid-19 Virus Infection Acute hypoxemic respiratory failure: Date of onset of symptoms: 11/19/23 Symptoms present on admission: Dizziness, weakness Date of covid positive test: 11/19/23 Vaccination status: vaccinated Imaging: CXR with mild bibasilar atelectasis vs airspace disease Oxygen requirements on admission: 2 Lpm by NC Current oxygen requirements: 2 Lpm by NC Medical therapy: steroids; remdesivir started by ID Consultants following: ID Anticipated special isolation end date: 11/30/2023   AKI on chronic kidney disease: Hyperkalemia: Creatinine baseline approximately 1.4  Creatinine on admission was 2.17   Hold lasix and Entresto IVFs Back to baseline on 11/22   Generalized weakness Fall  Acute on chronic back pain PT/OT Care management Fall precautions Thoracic lumbar and cervical x-rays-shows some severe degenerative ds Pt has seen Dr in past, will follow up with him as OP   Chronic CHFrEF: HTN: Hold Lasix and Entresto  elevated BNP to 2900 after fluids Toprol Stop IV fluids on 11/20   DVT: Warfarin per pharmacy   HLD: Atovastatin   Chronic pain syndrome: Continue home Butrans patch   GERD: PPI   IDDM2: Hold glipizide and metformin due to AKI Lantus and SSI
Age: 0.83
Sex: M
Vaccine: COVID19
Symptoms: Cough
Clinical narrative: occasional cough.
Age: 0.33
Sex: M
Vaccine: RV5
Symptoms: Diarrhoea, Gastrointestinal pathogen panel, Laboratory test abnormal, Pyrexia, Rotavirus infection
Clinical narrative: Documented Rotavirus symptomatic diarrhea, fever, weight loss 1 day after second dose of Rotateq.
Age: 0.33
Sex: M
Vaccine: RV5
Symptoms: Weight decreased
Clinical narrative: Documented Rotavirus symptomatic diarrhea, fever, weight loss 1 day after second dose of Rotateq.
Age: 89.0
Sex: M
Vaccine: PNC20
Symptoms: Unevaluable event
Clinical narrative: administered 14 months prior to eligibility
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Akinesia, Aspartate aminotransferase increased, Asthenia, Atrial fibrillation, Blood creatinine increased
Clinical narrative: Patient is a 74 y.o. male patient of MD with history of CHF, CAD, and A-fib s/p cryoablation, who presented to Hospital with fever Chills, and weakness found to have COVID infection.   COVID infection Sepsis Presentation with generalized weakness, chills, and fever. Febrile 101F on arrival, HR 76, RR 24, BP 125/69, satting 93% on RA. Patient does not need or require oxygen on admission. SIRS 2/4, qSOFA = 1 Initial CBC with WBC 8K. Lactate 2.3>1.9 CXR non acute findings. Received 30cc/kg of IVF in ED. Cont NS gtt @ 100cc/hr for additional 1L  Tested + for COVID. Isolation. No need for oxygen as not hypoxic.  Trend lactate normalized  BCx/Ucx NGTD Close monitoring of hemodynamics, goal MAP >65 Mucinex and tessalon for mucous and cough.  Not vaccinated for COVID.  Spoke with Dr. and will treat with IV Remdesivir x 3 days d/t no oxygen requirement. Normal LFT to start. AST mildly elevated after 2 doses.Will discharge following last dose today.  CRP improving today.     CHF Ischemic cardiomyopathy s/p biventricular ICD CAD s/p stent PAF s/p remote cryotherapy Last echo 5/21/2023 showed EF with to 23% with global hypokinesia. Last stress test perfusion defect in anterior septal, anterior, inferior septal, septal inferior, lateral, and apex walls is fixed consistent with previous infarct/scar.  Anteroseptal akinesis, and aneurysmal apex. Biventricular ICD upgrade on 10/17/2023 Labs negative for troponin. EKGs controlled A-fib with fascicular block. Continue home Eliquis, statin, Entresto, and Plavix. CKD stage III  Stable at baseline creat 1.3-1.4 Monitor daily with ongoing diuresis. Avoid nephrotoxic medications.   Hx PMR  Follows at the medical facility not currently on steroids    Prostate cancer  Follows at the medical facility
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Blood culture negative, Blood lactic acid, C-reactive protein abnormal, COVID-19, Cardiac aneurysm
Clinical narrative: Patient is a 74 y.o. male patient of MD with history of CHF, CAD, and A-fib s/p cryoablation, who presented to Hospital with fever Chills, and weakness found to have COVID infection.   COVID infection Sepsis Presentation with generalized weakness, chills, and fever. Febrile 101F on arrival, HR 76, RR 24, BP 125/69, satting 93% on RA. Patient does not need or require oxygen on admission. SIRS 2/4, qSOFA = 1 Initial CBC with WBC 8K. Lactate 2.3>1.9 CXR non acute findings. Received 30cc/kg of IVF in ED. Cont NS gtt @ 100cc/hr for additional 1L  Tested + for COVID. Isolation. No need for oxygen as not hypoxic.  Trend lactate normalized  BCx/Ucx NGTD Close monitoring of hemodynamics, goal MAP >65 Mucinex and tessalon for mucous and cough.  Not vaccinated for COVID.  Spoke with Dr. and will treat with IV Remdesivir x 3 days d/t no oxygen requirement. Normal LFT to start. AST mildly elevated after 2 doses.Will discharge following last dose today.  CRP improving today.     CHF Ischemic cardiomyopathy s/p biventricular ICD CAD s/p stent PAF s/p remote cryotherapy Last echo 5/21/2023 showed EF with to 23% with global hypokinesia. Last stress test perfusion defect in anterior septal, anterior, inferior septal, septal inferior, lateral, and apex walls is fixed consistent with previous infarct/scar.  Anteroseptal akinesis, and aneurysmal apex. Biventricular ICD upgrade on 10/17/2023 Labs negative for troponin. EKGs controlled A-fib with fascicular block. Continue home Eliquis, statin, Entresto, and Plavix. CKD stage III  Stable at baseline creat 1.3-1.4 Monitor daily with ongoing diuresis. Avoid nephrotoxic medications.   Hx PMR  Follows at the medical facility not currently on steroids    Prostate cancer  Follows at the medical facility
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Cardiac device replacement, Cardiac septal defect, Cardiac stress test abnormal, Chest X-ray normal, Chills
Clinical narrative: Patient is a 74 y.o. male patient of MD with history of CHF, CAD, and A-fib s/p cryoablation, who presented to Hospital with fever Chills, and weakness found to have COVID infection.   COVID infection Sepsis Presentation with generalized weakness, chills, and fever. Febrile 101F on arrival, HR 76, RR 24, BP 125/69, satting 93% on RA. Patient does not need or require oxygen on admission. SIRS 2/4, qSOFA = 1 Initial CBC with WBC 8K. Lactate 2.3>1.9 CXR non acute findings. Received 30cc/kg of IVF in ED. Cont NS gtt @ 100cc/hr for additional 1L  Tested + for COVID. Isolation. No need for oxygen as not hypoxic.  Trend lactate normalized  BCx/Ucx NGTD Close monitoring of hemodynamics, goal MAP >65 Mucinex and tessalon for mucous and cough.  Not vaccinated for COVID.  Spoke with Dr. and will treat with IV Remdesivir x 3 days d/t no oxygen requirement. Normal LFT to start. AST mildly elevated after 2 doses.Will discharge following last dose today.  CRP improving today.     CHF Ischemic cardiomyopathy s/p biventricular ICD CAD s/p stent PAF s/p remote cryotherapy Last echo 5/21/2023 showed EF with to 23% with global hypokinesia. Last stress test perfusion defect in anterior septal, anterior, inferior septal, septal inferior, lateral, and apex walls is fixed consistent with previous infarct/scar.  Anteroseptal akinesis, and aneurysmal apex. Biventricular ICD upgrade on 10/17/2023 Labs negative for troponin. EKGs controlled A-fib with fascicular block. Continue home Eliquis, statin, Entresto, and Plavix. CKD stage III  Stable at baseline creat 1.3-1.4 Monitor daily with ongoing diuresis. Avoid nephrotoxic medications.   Hx PMR  Follows at the medical facility not currently on steroids    Prostate cancer  Follows at the medical facility
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Condition aggravated, Cough, Culture urine negative, Diuretic therapy, Echocardiogram abnormal
Clinical narrative: Patient is a 74 y.o. male patient of MD with history of CHF, CAD, and A-fib s/p cryoablation, who presented to Hospital with fever Chills, and weakness found to have COVID infection.   COVID infection Sepsis Presentation with generalized weakness, chills, and fever. Febrile 101F on arrival, HR 76, RR 24, BP 125/69, satting 93% on RA. Patient does not need or require oxygen on admission. SIRS 2/4, qSOFA = 1 Initial CBC with WBC 8K. Lactate 2.3>1.9 CXR non acute findings. Received 30cc/kg of IVF in ED. Cont NS gtt @ 100cc/hr for additional 1L  Tested + for COVID. Isolation. No need for oxygen as not hypoxic.  Trend lactate normalized  BCx/Ucx NGTD Close monitoring of hemodynamics, goal MAP >65 Mucinex and tessalon for mucous and cough.  Not vaccinated for COVID.  Spoke with Dr. and will treat with IV Remdesivir x 3 days d/t no oxygen requirement. Normal LFT to start. AST mildly elevated after 2 doses.Will discharge following last dose today.  CRP improving today.     CHF Ischemic cardiomyopathy s/p biventricular ICD CAD s/p stent PAF s/p remote cryotherapy Last echo 5/21/2023 showed EF with to 23% with global hypokinesia. Last stress test perfusion defect in anterior septal, anterior, inferior septal, septal inferior, lateral, and apex walls is fixed consistent with previous infarct/scar.  Anteroseptal akinesis, and aneurysmal apex. Biventricular ICD upgrade on 10/17/2023 Labs negative for troponin. EKGs controlled A-fib with fascicular block. Continue home Eliquis, statin, Entresto, and Plavix. CKD stage III  Stable at baseline creat 1.3-1.4 Monitor daily with ongoing diuresis. Avoid nephrotoxic medications.   Hx PMR  Follows at the medical facility not currently on steroids    Prostate cancer  Follows at the medical facility
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Ejection fraction decreased, Electrocardiogram abnormal, Fascicular block, Full blood count, Myocardial fibrosis
Clinical narrative: Patient is a 74 y.o. male patient of MD with history of CHF, CAD, and A-fib s/p cryoablation, who presented to Hospital with fever Chills, and weakness found to have COVID infection.   COVID infection Sepsis Presentation with generalized weakness, chills, and fever. Febrile 101F on arrival, HR 76, RR 24, BP 125/69, satting 93% on RA. Patient does not need or require oxygen on admission. SIRS 2/4, qSOFA = 1 Initial CBC with WBC 8K. Lactate 2.3>1.9 CXR non acute findings. Received 30cc/kg of IVF in ED. Cont NS gtt @ 100cc/hr for additional 1L  Tested + for COVID. Isolation. No need for oxygen as not hypoxic.  Trend lactate normalized  BCx/Ucx NGTD Close monitoring of hemodynamics, goal MAP >65 Mucinex and tessalon for mucous and cough.  Not vaccinated for COVID.  Spoke with Dr. and will treat with IV Remdesivir x 3 days d/t no oxygen requirement. Normal LFT to start. AST mildly elevated after 2 doses.Will discharge following last dose today.  CRP improving today.     CHF Ischemic cardiomyopathy s/p biventricular ICD CAD s/p stent PAF s/p remote cryotherapy Last echo 5/21/2023 showed EF with to 23% with global hypokinesia. Last stress test perfusion defect in anterior septal, anterior, inferior septal, septal inferior, lateral, and apex walls is fixed consistent with previous infarct/scar.  Anteroseptal akinesis, and aneurysmal apex. Biventricular ICD upgrade on 10/17/2023 Labs negative for troponin. EKGs controlled A-fib with fascicular block. Continue home Eliquis, statin, Entresto, and Plavix. CKD stage III  Stable at baseline creat 1.3-1.4 Monitor daily with ongoing diuresis. Avoid nephrotoxic medications.   Hx PMR  Follows at the medical facility not currently on steroids    Prostate cancer  Follows at the medical facility
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Myocardial infarction, Pyrexia, SARS-CoV-2 test positive, Secretion discharge, Sepsis
Clinical narrative: Patient is a 74 y.o. male patient of MD with history of CHF, CAD, and A-fib s/p cryoablation, who presented to Hospital with fever Chills, and weakness found to have COVID infection.   COVID infection Sepsis Presentation with generalized weakness, chills, and fever. Febrile 101F on arrival, HR 76, RR 24, BP 125/69, satting 93% on RA. Patient does not need or require oxygen on admission. SIRS 2/4, qSOFA = 1 Initial CBC with WBC 8K. Lactate 2.3>1.9 CXR non acute findings. Received 30cc/kg of IVF in ED. Cont NS gtt @ 100cc/hr for additional 1L  Tested + for COVID. Isolation. No need for oxygen as not hypoxic.  Trend lactate normalized  BCx/Ucx NGTD Close monitoring of hemodynamics, goal MAP >65 Mucinex and tessalon for mucous and cough.  Not vaccinated for COVID.  Spoke with Dr. and will treat with IV Remdesivir x 3 days d/t no oxygen requirement. Normal LFT to start. AST mildly elevated after 2 doses.Will discharge following last dose today.  CRP improving today.     CHF Ischemic cardiomyopathy s/p biventricular ICD CAD s/p stent PAF s/p remote cryotherapy Last echo 5/21/2023 showed EF with to 23% with global hypokinesia. Last stress test perfusion defect in anterior septal, anterior, inferior septal, septal inferior, lateral, and apex walls is fixed consistent with previous infarct/scar.  Anteroseptal akinesis, and aneurysmal apex. Biventricular ICD upgrade on 10/17/2023 Labs negative for troponin. EKGs controlled A-fib with fascicular block. Continue home Eliquis, statin, Entresto, and Plavix. CKD stage III  Stable at baseline creat 1.3-1.4 Monitor daily with ongoing diuresis. Avoid nephrotoxic medications.   Hx PMR  Follows at the medical facility not currently on steroids    Prostate cancer  Follows at the medical facility
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Troponin normal, Ventricular hypokinesia, White blood cell count normal
Clinical narrative: Patient is a 74 y.o. male patient of MD with history of CHF, CAD, and A-fib s/p cryoablation, who presented to Hospital with fever Chills, and weakness found to have COVID infection.   COVID infection Sepsis Presentation with generalized weakness, chills, and fever. Febrile 101F on arrival, HR 76, RR 24, BP 125/69, satting 93% on RA. Patient does not need or require oxygen on admission. SIRS 2/4, qSOFA = 1 Initial CBC with WBC 8K. Lactate 2.3>1.9 CXR non acute findings. Received 30cc/kg of IVF in ED. Cont NS gtt @ 100cc/hr for additional 1L  Tested + for COVID. Isolation. No need for oxygen as not hypoxic.  Trend lactate normalized  BCx/Ucx NGTD Close monitoring of hemodynamics, goal MAP >65 Mucinex and tessalon for mucous and cough.  Not vaccinated for COVID.  Spoke with Dr. and will treat with IV Remdesivir x 3 days d/t no oxygen requirement. Normal LFT to start. AST mildly elevated after 2 doses.Will discharge following last dose today.  CRP improving today.     CHF Ischemic cardiomyopathy s/p biventricular ICD CAD s/p stent PAF s/p remote cryotherapy Last echo 5/21/2023 showed EF with to 23% with global hypokinesia. Last stress test perfusion defect in anterior septal, anterior, inferior septal, septal inferior, lateral, and apex walls is fixed consistent with previous infarct/scar.  Anteroseptal akinesis, and aneurysmal apex. Biventricular ICD upgrade on 10/17/2023 Labs negative for troponin. EKGs controlled A-fib with fascicular block. Continue home Eliquis, statin, Entresto, and Plavix. CKD stage III  Stable at baseline creat 1.3-1.4 Monitor daily with ongoing diuresis. Avoid nephrotoxic medications.   Hx PMR  Follows at the medical facility not currently on steroids    Prostate cancer  Follows at the medical facility
Age: 1.0
Sex: M
Vaccine: FLU4, HEPA, MMRV, VARCEL
Symptoms: Extra dose administered, No adverse event, Wrong product administered
Clinical narrative: Pt was given MMRV (Proquad) and Varicella vaccinations in the same visit. What was ordered and directed was the MMR vaccine and the Varicella vaccines separately. The medical assistant accident drew up the MMRV instead of MMR and then also gave Varicella.  Pt did not have any fevers, rashes, increased erythema at injection site or other known side effects. I checked on him 24h later and still without side effects.
Age: 64.0
Sex: F
Vaccine: VARZOS
Symptoms: Product storage error
Clinical narrative: Vaccine frozen instead of refrigerated
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Acute myocardial infarction, Atrial fibrillation, Blood magnesium, Blood potassium normal, Blood thyroid stimulating hormone normal
Clinical narrative: Patient is a 77 y.o. male patient of MD with a PMHx of OSA on CPAP, atrial tach, ESRD on HD, T2DM, SCC of esophagus, AAA, HTN presenting with dizziness, fevers, and tachycardia.   New onset atrial fibrillation with RVR NSTEMI, presumed type 2 from RVR and ESRD Hx of HTN, AAA Sent from HD center due to tachycardia, dizziness, fevers Afebrile on arrival, HR 130s, BP 106/66, satting >92% on RA K 4.5, Mg 2.0. Troponin 189. TSH 3.99 EKG (my read): AF RVR (Vrate 129), inferolateral TWI Last echo 2/2023 with EF 50%, G1DD, mild LAE Resume home Toprol (held on HD days), first dose now. Home midodrine bid Heparin gtt transitioned to Eliquis  Amio gtt transitioned to PO, target HR 60-110 Plan for TEE cardioversion tomorrow, NPO midnight Stress test outpatient in 4 weeks  Daily labs with goal K >4, Mg >2 Cardiology consulted   COVID-19 pneumonia Chronic hypoxemic resp failure OSA on CPAP Afebrile here but home temps of 102 per daughter Desatted to 88% in ED while sleeping but wears CPAP at home Initial CBC without leukocytosis CXR showing RUL and R basilar airspace disease c/w pneumonia Cont supplemental O2 to maintain goal SpO2 > 90% No new oxygen requirement so will hold off on Decadron Obtain baseline inflammatory markers Albuterol, robitussin-DM, tylenol PRN. Scheduled Mucinex, IS/PEP Will start CAP coverage with Rocephin/Doxycycline, can likely de-escalate in am Check SCx, urine antigens PT/OT/SW qHS CPAP ordered Daily labs    ESRD on HD Nephro consulted  T2DM, controlled Last A1c 6.1% but underestimated with HD Start SSI coverage   SCC esophagus No acute concerns Nutrition consult Hx throat cancer w/ radiaiton, anesthesia unable to intubate due to scarring, GI consult for evaluation of posterior pharynx and esophagus prior to reattempting.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Chest X-ray abnormal, Chronic respiratory failure, Condition aggravated, Diastolic dysfunction
Clinical narrative: Patient is a 77 y.o. male patient of MD with a PMHx of OSA on CPAP, atrial tach, ESRD on HD, T2DM, SCC of esophagus, AAA, HTN presenting with dizziness, fevers, and tachycardia.   New onset atrial fibrillation with RVR NSTEMI, presumed type 2 from RVR and ESRD Hx of HTN, AAA Sent from HD center due to tachycardia, dizziness, fevers Afebrile on arrival, HR 130s, BP 106/66, satting >92% on RA K 4.5, Mg 2.0. Troponin 189. TSH 3.99 EKG (my read): AF RVR (Vrate 129), inferolateral TWI Last echo 2/2023 with EF 50%, G1DD, mild LAE Resume home Toprol (held on HD days), first dose now. Home midodrine bid Heparin gtt transitioned to Eliquis  Amio gtt transitioned to PO, target HR 60-110 Plan for TEE cardioversion tomorrow, NPO midnight Stress test outpatient in 4 weeks  Daily labs with goal K >4, Mg >2 Cardiology consulted   COVID-19 pneumonia Chronic hypoxemic resp failure OSA on CPAP Afebrile here but home temps of 102 per daughter Desatted to 88% in ED while sleeping but wears CPAP at home Initial CBC without leukocytosis CXR showing RUL and R basilar airspace disease c/w pneumonia Cont supplemental O2 to maintain goal SpO2 > 90% No new oxygen requirement so will hold off on Decadron Obtain baseline inflammatory markers Albuterol, robitussin-DM, tylenol PRN. Scheduled Mucinex, IS/PEP Will start CAP coverage with Rocephin/Doxycycline, can likely de-escalate in am Check SCx, urine antigens PT/OT/SW qHS CPAP ordered Daily labs    ESRD on HD Nephro consulted  T2DM, controlled Last A1c 6.1% but underestimated with HD Start SSI coverage   SCC esophagus No acute concerns Nutrition consult Hx throat cancer w/ radiaiton, anesthesia unable to intubate due to scarring, GI consult for evaluation of posterior pharynx and esophagus prior to reattempting.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Dizziness, Echocardiogram abnormal, Ejection fraction, Electrocardiogram T wave inversion, Electrocardiogram abnormal
Clinical narrative: Patient is a 77 y.o. male patient of MD with a PMHx of OSA on CPAP, atrial tach, ESRD on HD, T2DM, SCC of esophagus, AAA, HTN presenting with dizziness, fevers, and tachycardia.   New onset atrial fibrillation with RVR NSTEMI, presumed type 2 from RVR and ESRD Hx of HTN, AAA Sent from HD center due to tachycardia, dizziness, fevers Afebrile on arrival, HR 130s, BP 106/66, satting >92% on RA K 4.5, Mg 2.0. Troponin 189. TSH 3.99 EKG (my read): AF RVR (Vrate 129), inferolateral TWI Last echo 2/2023 with EF 50%, G1DD, mild LAE Resume home Toprol (held on HD days), first dose now. Home midodrine bid Heparin gtt transitioned to Eliquis  Amio gtt transitioned to PO, target HR 60-110 Plan for TEE cardioversion tomorrow, NPO midnight Stress test outpatient in 4 weeks  Daily labs with goal K >4, Mg >2 Cardiology consulted   COVID-19 pneumonia Chronic hypoxemic resp failure OSA on CPAP Afebrile here but home temps of 102 per daughter Desatted to 88% in ED while sleeping but wears CPAP at home Initial CBC without leukocytosis CXR showing RUL and R basilar airspace disease c/w pneumonia Cont supplemental O2 to maintain goal SpO2 > 90% No new oxygen requirement so will hold off on Decadron Obtain baseline inflammatory markers Albuterol, robitussin-DM, tylenol PRN. Scheduled Mucinex, IS/PEP Will start CAP coverage with Rocephin/Doxycycline, can likely de-escalate in am Check SCx, urine antigens PT/OT/SW qHS CPAP ordered Daily labs    ESRD on HD Nephro consulted  T2DM, controlled Last A1c 6.1% but underestimated with HD Start SSI coverage   SCC esophagus No acute concerns Nutrition consult Hx throat cancer w/ radiaiton, anesthesia unable to intubate due to scarring, GI consult for evaluation of posterior pharynx and esophagus prior to reattempting.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: End stage renal disease, Full blood count normal, Glycosylated haemoglobin normal, Haemodialysis, Left atrial enlargement
Clinical narrative: Patient is a 77 y.o. male patient of MD with a PMHx of OSA on CPAP, atrial tach, ESRD on HD, T2DM, SCC of esophagus, AAA, HTN presenting with dizziness, fevers, and tachycardia.   New onset atrial fibrillation with RVR NSTEMI, presumed type 2 from RVR and ESRD Hx of HTN, AAA Sent from HD center due to tachycardia, dizziness, fevers Afebrile on arrival, HR 130s, BP 106/66, satting >92% on RA K 4.5, Mg 2.0. Troponin 189. TSH 3.99 EKG (my read): AF RVR (Vrate 129), inferolateral TWI Last echo 2/2023 with EF 50%, G1DD, mild LAE Resume home Toprol (held on HD days), first dose now. Home midodrine bid Heparin gtt transitioned to Eliquis  Amio gtt transitioned to PO, target HR 60-110 Plan for TEE cardioversion tomorrow, NPO midnight Stress test outpatient in 4 weeks  Daily labs with goal K >4, Mg >2 Cardiology consulted   COVID-19 pneumonia Chronic hypoxemic resp failure OSA on CPAP Afebrile here but home temps of 102 per daughter Desatted to 88% in ED while sleeping but wears CPAP at home Initial CBC without leukocytosis CXR showing RUL and R basilar airspace disease c/w pneumonia Cont supplemental O2 to maintain goal SpO2 > 90% No new oxygen requirement so will hold off on Decadron Obtain baseline inflammatory markers Albuterol, robitussin-DM, tylenol PRN. Scheduled Mucinex, IS/PEP Will start CAP coverage with Rocephin/Doxycycline, can likely de-escalate in am Check SCx, urine antigens PT/OT/SW qHS CPAP ordered Daily labs    ESRD on HD Nephro consulted  T2DM, controlled Last A1c 6.1% but underestimated with HD Start SSI coverage   SCC esophagus No acute concerns Nutrition consult Hx throat cancer w/ radiaiton, anesthesia unable to intubate due to scarring, GI consult for evaluation of posterior pharynx and esophagus prior to reattempting.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Lung disorder, Obstructive sleep apnoea syndrome, Oxygen saturation decreased, Positive airway pressure therapy, Pyrexia
Clinical narrative: Patient is a 77 y.o. male patient of MD with a PMHx of OSA on CPAP, atrial tach, ESRD on HD, T2DM, SCC of esophagus, AAA, HTN presenting with dizziness, fevers, and tachycardia.   New onset atrial fibrillation with RVR NSTEMI, presumed type 2 from RVR and ESRD Hx of HTN, AAA Sent from HD center due to tachycardia, dizziness, fevers Afebrile on arrival, HR 130s, BP 106/66, satting >92% on RA K 4.5, Mg 2.0. Troponin 189. TSH 3.99 EKG (my read): AF RVR (Vrate 129), inferolateral TWI Last echo 2/2023 with EF 50%, G1DD, mild LAE Resume home Toprol (held on HD days), first dose now. Home midodrine bid Heparin gtt transitioned to Eliquis  Amio gtt transitioned to PO, target HR 60-110 Plan for TEE cardioversion tomorrow, NPO midnight Stress test outpatient in 4 weeks  Daily labs with goal K >4, Mg >2 Cardiology consulted   COVID-19 pneumonia Chronic hypoxemic resp failure OSA on CPAP Afebrile here but home temps of 102 per daughter Desatted to 88% in ED while sleeping but wears CPAP at home Initial CBC without leukocytosis CXR showing RUL and R basilar airspace disease c/w pneumonia Cont supplemental O2 to maintain goal SpO2 > 90% No new oxygen requirement so will hold off on Decadron Obtain baseline inflammatory markers Albuterol, robitussin-DM, tylenol PRN. Scheduled Mucinex, IS/PEP Will start CAP coverage with Rocephin/Doxycycline, can likely de-escalate in am Check SCx, urine antigens PT/OT/SW qHS CPAP ordered Daily labs    ESRD on HD Nephro consulted  T2DM, controlled Last A1c 6.1% but underestimated with HD Start SSI coverage   SCC esophagus No acute concerns Nutrition consult Hx throat cancer w/ radiaiton, anesthesia unable to intubate due to scarring, GI consult for evaluation of posterior pharynx and esophagus prior to reattempting.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Respiratory failure, Tachycardia, Troponin increased
Clinical narrative: Patient is a 77 y.o. male patient of MD with a PMHx of OSA on CPAP, atrial tach, ESRD on HD, T2DM, SCC of esophagus, AAA, HTN presenting with dizziness, fevers, and tachycardia.   New onset atrial fibrillation with RVR NSTEMI, presumed type 2 from RVR and ESRD Hx of HTN, AAA Sent from HD center due to tachycardia, dizziness, fevers Afebrile on arrival, HR 130s, BP 106/66, satting >92% on RA K 4.5, Mg 2.0. Troponin 189. TSH 3.99 EKG (my read): AF RVR (Vrate 129), inferolateral TWI Last echo 2/2023 with EF 50%, G1DD, mild LAE Resume home Toprol (held on HD days), first dose now. Home midodrine bid Heparin gtt transitioned to Eliquis  Amio gtt transitioned to PO, target HR 60-110 Plan for TEE cardioversion tomorrow, NPO midnight Stress test outpatient in 4 weeks  Daily labs with goal K >4, Mg >2 Cardiology consulted   COVID-19 pneumonia Chronic hypoxemic resp failure OSA on CPAP Afebrile here but home temps of 102 per daughter Desatted to 88% in ED while sleeping but wears CPAP at home Initial CBC without leukocytosis CXR showing RUL and R basilar airspace disease c/w pneumonia Cont supplemental O2 to maintain goal SpO2 > 90% No new oxygen requirement so will hold off on Decadron Obtain baseline inflammatory markers Albuterol, robitussin-DM, tylenol PRN. Scheduled Mucinex, IS/PEP Will start CAP coverage with Rocephin/Doxycycline, can likely de-escalate in am Check SCx, urine antigens PT/OT/SW qHS CPAP ordered Daily labs    ESRD on HD Nephro consulted  T2DM, controlled Last A1c 6.1% but underestimated with HD Start SSI coverage   SCC esophagus No acute concerns Nutrition consult Hx throat cancer w/ radiaiton, anesthesia unable to intubate due to scarring, GI consult for evaluation of posterior pharynx and esophagus prior to reattempting.
Age: 53.0
Sex: F
Vaccine: VARZOS
Symptoms: Product storage error
Clinical narrative: VACCINE FROZEN INSTEAD OF REFRIGERATED