chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Pneumonia staphylococcal, Positive airway pressure therapy, Respiratory distress, Respiratory failure, Sinus tachycardia
Clinical narrative: Patient is a 62 y.o. male, nursing home resident with history of end-stage COPD on 4L NC at home, hypertension, hyperlipidemia, CHF, alcohol abuse, diabetes mellitus type 2, who presented to Country Hospital with respiratory distress and hypoxia then transferred to General Hospital.    Goal of care Palliative following, pt with very poor prognosis, advanced COPD on Vent due to COVID with multiple complications.  Discussed with family and code status changed to DNR CC, compassion extubation done 11/22. Pt to be admitted to inpt hospice.  Comfort medication ordered.    Acute on chronic hypoxic hypercapnic respiratory failure Acute COPD exacerbation COVID 19 with ARDS MRSA cavitary pneumonia Possibly COPD exacerbation precipitated by COVID infection. Patient oxygen home requirement on 4 L nasal cannula. Required BIPAP and later intubated at County before transferring to on 11/13. Sputum culture 11/14 + MRSA Antibiotics changed from Rocephin and azithromycin to vancomycin. Cefepime clinda started on 11/20 for arm cellulitis Received remdesevir and dexamethasone.   CT chest repeated today (11/20) Multiple cavitating lesions in the right lung, probable cavitating pneumonia Pulmonary following   Off pressors since 11/16 Compassion extubation 11/22/23   Left upper extremity cellulitis Noted worsening erythema and edema of LUE 11/20. CT arm  Multiple foci of air density are identified within the soft tissues along the medial aspect of the left upper arm,  findings suspicious for necrotizing infection with a gas-forming organism/necrotizing fasciitis Surgery took pt to OR, no clear signs of Nec fasc, I&D done 11/20. Wound cultures negative  Received  Cefepime, clinda, Vancomycin Wound care   Thrombocytopenia Chronic anemia Platelets remains low at 122k, no signs of bleeding. Hb stable ~11 Due to acute illness monitor   Uremia Ongoing uremia, BUN improving 58. normal Cr I/O overall even, but -1.5L in the last 24 hrs. Monitor for now   HFpEF, chronic Hypertension EKG showed sinus tachycardia with no acute ischemic changes. Initial hypotension requiring pressors, now resolved.  Metoprolol initiated 11/17 Diabetes mellitus type 2 complicated with peripheral neuropathy Blood glucose 120, and last A1c 14%. HA1C 7.4. Continue Lantus and Monitor blood glucose and start SSI during admission. Continue home gabapentin.   Alcoholic liver cirrhosis with Ascites History of alcohol abuse hold home lasix and spironolactone.   schizoaffective disorder Bipolar disorder History of seizure Continue home Abilify, and Keppra.   Morbid obesity BMI 32.77 kg/M2. Lifestyle modification is recommended.
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Soft tissue necrosis, Sputum culture positive, Staphylococcus test positive, Thrombocytopenia
Clinical narrative: Patient is a 62 y.o. male, nursing home resident with history of end-stage COPD on 4L NC at home, hypertension, hyperlipidemia, CHF, alcohol abuse, diabetes mellitus type 2, who presented to Country Hospital with respiratory distress and hypoxia then transferred to General Hospital.    Goal of care Palliative following, pt with very poor prognosis, advanced COPD on Vent due to COVID with multiple complications.  Discussed with family and code status changed to DNR CC, compassion extubation done 11/22. Pt to be admitted to inpt hospice.  Comfort medication ordered.    Acute on chronic hypoxic hypercapnic respiratory failure Acute COPD exacerbation COVID 19 with ARDS MRSA cavitary pneumonia Possibly COPD exacerbation precipitated by COVID infection. Patient oxygen home requirement on 4 L nasal cannula. Required BIPAP and later intubated at County before transferring to on 11/13. Sputum culture 11/14 + MRSA Antibiotics changed from Rocephin and azithromycin to vancomycin. Cefepime clinda started on 11/20 for arm cellulitis Received remdesevir and dexamethasone.   CT chest repeated today (11/20) Multiple cavitating lesions in the right lung, probable cavitating pneumonia Pulmonary following   Off pressors since 11/16 Compassion extubation 11/22/23   Left upper extremity cellulitis Noted worsening erythema and edema of LUE 11/20. CT arm  Multiple foci of air density are identified within the soft tissues along the medial aspect of the left upper arm,  findings suspicious for necrotizing infection with a gas-forming organism/necrotizing fasciitis Surgery took pt to OR, no clear signs of Nec fasc, I&D done 11/20. Wound cultures negative  Received  Cefepime, clinda, Vancomycin Wound care   Thrombocytopenia Chronic anemia Platelets remains low at 122k, no signs of bleeding. Hb stable ~11 Due to acute illness monitor   Uremia Ongoing uremia, BUN improving 58. normal Cr I/O overall even, but -1.5L in the last 24 hrs. Monitor for now   HFpEF, chronic Hypertension EKG showed sinus tachycardia with no acute ischemic changes. Initial hypotension requiring pressors, now resolved.  Metoprolol initiated 11/17 Diabetes mellitus type 2 complicated with peripheral neuropathy Blood glucose 120, and last A1c 14%. HA1C 7.4. Continue Lantus and Monitor blood glucose and start SSI during admission. Continue home gabapentin.   Alcoholic liver cirrhosis with Ascites History of alcohol abuse hold home lasix and spironolactone.   schizoaffective disorder Bipolar disorder History of seizure Continue home Abilify, and Keppra.   Morbid obesity BMI 32.77 kg/M2. Lifestyle modification is recommended.
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Death
Clinical narrative: Covid-related death
Age: 0.5
Sex: U
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Patient received correct COVID vaccine for age, manufacturer expiration date was not expired, but date added by pharmacy as "best use by date" was expired on 12/18/2023.
Age: 0.5
Sex: F
Vaccine: UNK
Symptoms: Unevaluable event
Clinical narrative: Patient received correct COVID vaccine for age, manufacturer expiration date was not expired, but date added by pharmacy as "best use by date" was expired on 12/18/2023.
Age: 3.0
Sex: M
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Patient received correct COVID vaccine for age, manufacturer expiration date was not expired, but date added by pharmacy as "best use by date" was expired on 12/18/2023.
Age: 5.0
Sex: M
Vaccine: COVID19
Symptoms: No adverse event
Clinical narrative: None stated
Age: 1.17
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Patient received correct COVID vaccine for age, manufacturer expiration date was not expired, but date added by pharmacy as "best use by date" was expired on 12/18/2023.
Age: 61.0
Sex: M
Vaccine: VARZOS
Symptoms: Unevaluable event
Clinical narrative: Vaccine Refridgerated
Sex: F
Vaccine: COVID19
Symptoms: No adverse event
Clinical narrative: None stated
Age: 0.75
Sex: M
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Patient received correct COVID vaccine for age, manufacturer expiration date was not expired, but date added by pharmacy as "best use by date" was expired on 12/18/2023.
Age: 11.0
Sex: M
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Patient received correct COVID vaccine for age, manufacturer expiration date was not expired, but date added by pharmacy as "best use by date" was expired on 12/18/2023.
Age: 62.0
Sex: F
Vaccine: VARZOS
Symptoms: Product storage error
Clinical narrative: VACCINE FORZEN INSTEAD OF REFRIGERATED
Age: 56.0
Sex: M
Vaccine: VARZOS, VARZOS
Symptoms: Unevaluable event
Clinical narrative: None stated.
Age: 1.75
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Patient received correct COVID vaccine for age, manufacturer expiration date was not expired, but date added by pharmacy as "best use by date" was expired on 12/18/2023.
Age: 9.0
Sex: M
Vaccine: COVID19
Symptoms: No adverse event, Product administered to patient of inappropriate age
Clinical narrative: 2:30 Moderna COVID vaccine Lot # 3032265, NDC 80777-102-93, exp 05/15/2024, admin to L deltoid with parent and patient consent. Tol well, hemostasis achieved.    3:40 This writer realized when documenting that adult COVID vaccine was admin in error for 9 year old.   Lot 3032265. Message to provider. Face sheet taken to provider for advice. 3:50 Advised by Dr to phone parent and explain.   Phoned pt's mother. Informed patient was given the adult dose of the COVID vaccine in error. Informed her Dr is aware and will call later, but no harm to her son is expected. Informed that 12 year-olds get the adult dose, but there is a different vaccine for 9 year-olds. Explained that this dose would likely provide more protection against COVID virus. She v/u.  Apologized for the mistake, informing parent I did not follow clinic policy of entering order before administering vaccines, and would never miss this step again.  She v/u.  Informed that Dr would be calling her later to follow-up on this, and answer any further questions. 5:00 pm: Provider noted "I reached out to the patient's mother to apologize for the mistake and check on patient.  She states he feels amazing and there is no side effect so far.  I reassured her that the risk for complications is low but to watch him for high fevers, aches, headaches.  She understands and will contact us if there are any concerns." 12/19/2023 Parent called with report of parent c/o headache and vomited x 3 this morning. No fever. Provider replied "I called mom and discussed the patient's situation.  He has no fever but has had headache and malaise and chills.  He has had several episodes of vomiting a day but he feels well in between.  No diarrhea.  He is able to take in clear liquids and eat a little toes.  She declines Zofran and does not think he needs to go to the emergency department.  Continue to hydrate and call us back if symptoms persist or worsen.  I assuming this is a side effect of the erroneous adult dose of the COVID-vaccine that was given by mistake yesterday."
Age: 89.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Atrial fibrillation, COVID-19, Cardiac failure acute, Cough
Clinical narrative: Pt is a 90 y/o male with history noted above. Now presents with dyspnea over the last 7 days with cough. Reports nonproductive cough, worsening dyspnea on exertion. Also reports orthopnea with increased leg swelling, denies chest pain, fever or chills, n/v/d, abdominal pain. He denies recent sick contacts.    Workup in ED: acute hypoxic respiratory failure on arrival. Found to be fluid overloaded and COVID positive. Admission for supportive care, continued O2 therapy, diuresis, ID and cardio consults.    Clinical Summary Patient was weaned off oxygen for acute respiratory failure due to covid.  Patient completed a course of remdesivir and has been stable.  Placement has been an issue as patient requires care takers at home and they would not come into the home until patient is out of his quarantine period and SNF had reported the same.  Patient is now 10 days out from testing positive and will be discharged to SNF with instructions to follow up with PCP.  No medication changes were made and VS and labs have been stable otherwise.   Discharge diagnosis Acute hypoxic respiratory failure COVID-19 infection without pneumonia Acute on chronic diastolic heart failure Valvular heart failure Severe tricuspid regurgitation Permanent atrial fibrillation Hypertension Seizure history
Age: 89.0
Sex: M
Vaccine: COVID19-2
Symptoms: Diuretic therapy, Dyspnoea, Dyspnoea exertional, Hypertension, Hypervolaemia
Clinical narrative: Pt is a 90 y/o male with history noted above. Now presents with dyspnea over the last 7 days with cough. Reports nonproductive cough, worsening dyspnea on exertion. Also reports orthopnea with increased leg swelling, denies chest pain, fever or chills, n/v/d, abdominal pain. He denies recent sick contacts.    Workup in ED: acute hypoxic respiratory failure on arrival. Found to be fluid overloaded and COVID positive. Admission for supportive care, continued O2 therapy, diuresis, ID and cardio consults.    Clinical Summary Patient was weaned off oxygen for acute respiratory failure due to covid.  Patient completed a course of remdesivir and has been stable.  Placement has been an issue as patient requires care takers at home and they would not come into the home until patient is out of his quarantine period and SNF had reported the same.  Patient is now 10 days out from testing positive and will be discharged to SNF with instructions to follow up with PCP.  No medication changes were made and VS and labs have been stable otherwise.   Discharge diagnosis Acute hypoxic respiratory failure COVID-19 infection without pneumonia Acute on chronic diastolic heart failure Valvular heart failure Severe tricuspid regurgitation Permanent atrial fibrillation Hypertension Seizure history
Age: 89.0
Sex: M
Vaccine: COVID19-2
Symptoms: Left ventricular failure, Orthopnoea, Peripheral swelling, SARS-CoV-2 test positive, Tricuspid valve incompetence
Clinical narrative: Pt is a 90 y/o male with history noted above. Now presents with dyspnea over the last 7 days with cough. Reports nonproductive cough, worsening dyspnea on exertion. Also reports orthopnea with increased leg swelling, denies chest pain, fever or chills, n/v/d, abdominal pain. He denies recent sick contacts.    Workup in ED: acute hypoxic respiratory failure on arrival. Found to be fluid overloaded and COVID positive. Admission for supportive care, continued O2 therapy, diuresis, ID and cardio consults.    Clinical Summary Patient was weaned off oxygen for acute respiratory failure due to covid.  Patient completed a course of remdesivir and has been stable.  Placement has been an issue as patient requires care takers at home and they would not come into the home until patient is out of his quarantine period and SNF had reported the same.  Patient is now 10 days out from testing positive and will be discharged to SNF with instructions to follow up with PCP.  No medication changes were made and VS and labs have been stable otherwise.   Discharge diagnosis Acute hypoxic respiratory failure COVID-19 infection without pneumonia Acute on chronic diastolic heart failure Valvular heart failure Severe tricuspid regurgitation Permanent atrial fibrillation Hypertension Seizure history
Age: 66.0
Sex: U
Vaccine: UNK, UNK
Symptoms: Burning sensation, Myalgia, Pain, Temperature intolerance, Tenderness
Clinical narrative: On the 22, I felt a "muscular" pain at left back site. On the 23, the pair irradiated to same line to front. With 3 points like insect bites, wich increase in number and size. Pain was intense an intolarance to touch and cold thingds, feeling. like burning. The I was diagnose by my nephew neurologistf, who was visiting. I went to a drugs store where they gave me actclovir in cream and 3 days later my sister, pharmacist, sent valtrex. I am still with sinptoms.
Age: 81.0
Sex: F
Vaccine: VARZOS
Symptoms: Unevaluable event
Clinical narrative: Vaccine Refridgerated
Age: 1.08
Sex: M
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Patient received correct COVID vaccine for age, manufacturer expiration date was not expired, but date added by pharmacy as "best use by date" was expired on 12/18/2023.
Age: 8.0
Sex: M
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Patient received correct COVID vaccine for age, manufacturer expiration date was not expired, but date added by pharmacy as "best use by date" was expired on 12/18/2023.
Age: 8.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Patient received correct COVID vaccine for age, manufacturer expiration date was not expired, but date added by pharmacy as "best use by date" was expired on 12/18/2023.
Age: 36.0
Sex: F
Vaccine: COVID19-2
Symptoms: Palpitations
Clinical narrative: Pounding heart beat
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Angiogram cerebral abnormal, Aphasia, Arteriogram carotid normal, Cerebral infarction, Cerebral ischaemia
Clinical narrative: PRESENTED WITH LEFT MCA STROKE REQUIRING THROMBECTOMY. SYMPTOMS BEGAN 12/28 WITH RIGHT SIDED WEAKNESS AND INABILITY TO SPEAK.
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Echocardiogram, Echocardiogram normal, Ejection fraction normal, Hemiparesis, Middle cerebral artery stroke
Clinical narrative: PRESENTED WITH LEFT MCA STROKE REQUIRING THROMBECTOMY. SYMPTOMS BEGAN 12/28 WITH RIGHT SIDED WEAKNESS AND INABILITY TO SPEAK.
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Perfusion brain scan abnormal, Thrombectomy
Clinical narrative: PRESENTED WITH LEFT MCA STROKE REQUIRING THROMBECTOMY. SYMPTOMS BEGAN 12/28 WITH RIGHT SIDED WEAKNESS AND INABILITY TO SPEAK.
Age: 6.0
Sex: M
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Patient received correct COVID vaccine for age, manufacturer expiration date was not expired, but date added by pharmacy as "best use by date" was expired on 12/18/2023.
Age: 0.42
Sex: M
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Patient received correct COVID vaccine for age, manufacturer expiration date was not expired, but date added by pharmacy as "best use by date" was expired on 12/18/2023.
Age: 83.0
Sex: M
Vaccine: COVID19-2
Symptoms: Agitation, Aspiration, Asthenia, COVID-19, Death
Clinical narrative: From Dr.'s admission H&P: "Patient is an 84-year-old male with history of multiple chronic illnesses who recently had COVID-19 and aspiration pneumonia leading to respiratory failure with hypoxemia.  During his hospital stay, he had progressive debility including dysphagia needing NG tube feeds however family decision was made to transition to hospice and comfort care, tube feeds were discontinued and patient continued to have agitation and lethargy.  He is requiring sublingual oxycodone and IV Ativan while at the hospital."   Patient had evidence of aspiration with moderate pulmonary secretions, so his medications were changed to IV/SQ route with improvement of secretions.  Hydromorphone at 0.5 mg every 4 hours was effective and lorazepam was continued at 1 mg every 8 hours.  Patient declined over the course of approximately a week, and died expectedly on 12/1/2023.
Age: 83.0
Sex: M
Vaccine: COVID19-2
Symptoms: Dysphagia, Gastrointestinal tube insertion, General physical health deterioration, Hypoxia, Lethargy
Clinical narrative: From Dr.'s admission H&P: "Patient is an 84-year-old male with history of multiple chronic illnesses who recently had COVID-19 and aspiration pneumonia leading to respiratory failure with hypoxemia.  During his hospital stay, he had progressive debility including dysphagia needing NG tube feeds however family decision was made to transition to hospice and comfort care, tube feeds were discontinued and patient continued to have agitation and lethargy.  He is requiring sublingual oxycodone and IV Ativan while at the hospital."   Patient had evidence of aspiration with moderate pulmonary secretions, so his medications were changed to IV/SQ route with improvement of secretions.  Hydromorphone at 0.5 mg every 4 hours was effective and lorazepam was continued at 1 mg every 8 hours.  Patient declined over the course of approximately a week, and died expectedly on 12/1/2023.
Age: 83.0
Sex: M
Vaccine: COVID19-2
Symptoms: Pneumonia aspiration, Respiratory failure, Secretion discharge
Clinical narrative: From Dr.'s admission H&P: "Patient is an 84-year-old male with history of multiple chronic illnesses who recently had COVID-19 and aspiration pneumonia leading to respiratory failure with hypoxemia.  During his hospital stay, he had progressive debility including dysphagia needing NG tube feeds however family decision was made to transition to hospice and comfort care, tube feeds were discontinued and patient continued to have agitation and lethargy.  He is requiring sublingual oxycodone and IV Ativan while at the hospital."   Patient had evidence of aspiration with moderate pulmonary secretions, so his medications were changed to IV/SQ route with improvement of secretions.  Hydromorphone at 0.5 mg every 4 hours was effective and lorazepam was continued at 1 mg every 8 hours.  Patient declined over the course of approximately a week, and died expectedly on 12/1/2023.
Age: 59.0
Sex: M
Vaccine: VARZOS
Symptoms: Unevaluable event
Clinical narrative: VACCINE REFRIGERATED INSTEAD OF FROZEN
Age: 68.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Unevaluable event
Clinical narrative: None stated.
Age: 2.0
Sex: F
Vaccine: COVID19
Symptoms: No adverse event
Clinical narrative: None stated
Age: 58.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Unevaluable event
Clinical narrative: Vaccine Refridgerated
Age: 5.0
Sex: F
Vaccine: COVID19
Symptoms: No adverse event
Clinical narrative: None stated
Age: 75.0
Sex: M
Vaccine: FLU4
Symptoms: Needle issue
Clinical narrative: While pharmacy intern was administering the vaccine to the patient, the needle became obstructed by an unknown object. The intern experienced resistance while trying to push the plunger of the syringe. The dose was not administered, and the needle had to be changed. After changing the needle, the intern administered the vaccine again.  Patient endured two needle jabs for one vaccine.
Age: 65.0
Sex: F
Vaccine: FLU4
Symptoms: Extra dose administered
Clinical narrative: Pt had high dose flu vaccine on 10-13-23.  requested flu again today and it was given.
Age: 78.0
Sex: M
Vaccine: VARZOS
Symptoms: Headache, Injection site pain, Malaise, Nausea
Clinical narrative: Adverse effects may be considered with the normal range. I believe the benefit of  protection provided by this vaccine outweighs the adverse effects experienced. Soon after injection: pain at injection site. Following morning : nausea, slight headache, generally unwell. Ceased any activity, drank as much water as possible at least 2 litres and went to bed. Slept when  possible intermittently for short periods then finally for about two - three hours. Awoke at 5:45pm to feel recovered with no nausea and had water and light food after food fast all day.
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, CSF white blood cell count increased, Chest X-ray normal, Chills, Computerised tomogram head normal
Clinical narrative: Patient is a 53 y.o. male patient of MD with history of depression, hypertension, DM type II presented to Hospital with altered mental status and fever  Assessment and Plan   Acute febrile illness Altered mental status Febrile for 10 days PTA along with headache and chills Not associated with other gross neurological deficits or meningismus. Afebrile on presentation; hemodynamically stable. No meningeal signs CT brain w/o acute gross abnormalities.  In setting of recent viral infection, lumbar puncture was performed in the ED  Empirically received IV vancomycin, ceftriaxone, acyclovir, dexamethasone LP findings reviewed, Increased white count at 11 with lymphocytosis in CSF CSF PCR negative. Discussed with ID Dr,  DCd acyclovir and ampicillin given HSV and Listeria PCR negative on11/23 Received phone call from patient's PCP Dr, patient has multiple sexual partners, ordered CSF VDRL, syphilis antibody, HIV testing Patient had history of for possible syphilis, treated with penicillin a year ago.  Syphilis antibody positive because of previous history MRI findings- no new stroke, chronic white matter changes related to due trauma/inflammation/demyelination, or chronic ischemia associated with migraine/atherosclerosis. ID consulted for concern for possible neurosyphilis.  Consult appreciated suspected LP findings probably secondary to aseptic meningitis/COVID meningitis MRI changes related to recent COVID infection.  Recommended to stop antibiotics.  His presentation does not correspond to neurosyphilis as per ID.  Recommended possible repeat lumbar puncture in 2 months to completely rule out neurosyphilis.  Patient to follow-up with ID as an outpatient. Evaluated by neurology.  No further inpatient work-up.  Mental status is back to baseline.  Discharged home in stable condition.       Obesity Dietary modifications as outpatient   Covid-19 Virus Infection Date of onset of symptoms: 11/16/23 Symptoms present on admission: Malaise, subjective fevers/chills Date of covid positive test: Home test (11/17/23); confirmed on 11/23/23 (hospital). Vaccination status: unknown Imaging: CXR without acute gross abnormalities Oxygen requirements on admission: None Medical therapy: not indicated Consultants following: None Isolation can be discontinued after discharge Hypertension: Normotensive on admission. Resume home regimen     DM type II: On Lantus and SSI, continue the same     Depression: Associated with ADHD. Restart home regimen.
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: HIV test, Headache, Herpes simplex test negative, Listeria test, Lymphocytosis
Clinical narrative: Patient is a 53 y.o. male patient of MD with history of depression, hypertension, DM type II presented to Hospital with altered mental status and fever  Assessment and Plan   Acute febrile illness Altered mental status Febrile for 10 days PTA along with headache and chills Not associated with other gross neurological deficits or meningismus. Afebrile on presentation; hemodynamically stable. No meningeal signs CT brain w/o acute gross abnormalities.  In setting of recent viral infection, lumbar puncture was performed in the ED  Empirically received IV vancomycin, ceftriaxone, acyclovir, dexamethasone LP findings reviewed, Increased white count at 11 with lymphocytosis in CSF CSF PCR negative. Discussed with ID Dr,  DCd acyclovir and ampicillin given HSV and Listeria PCR negative on11/23 Received phone call from patient's PCP Dr, patient has multiple sexual partners, ordered CSF VDRL, syphilis antibody, HIV testing Patient had history of for possible syphilis, treated with penicillin a year ago.  Syphilis antibody positive because of previous history MRI findings- no new stroke, chronic white matter changes related to due trauma/inflammation/demyelination, or chronic ischemia associated with migraine/atherosclerosis. ID consulted for concern for possible neurosyphilis.  Consult appreciated suspected LP findings probably secondary to aseptic meningitis/COVID meningitis MRI changes related to recent COVID infection.  Recommended to stop antibiotics.  His presentation does not correspond to neurosyphilis as per ID.  Recommended possible repeat lumbar puncture in 2 months to completely rule out neurosyphilis.  Patient to follow-up with ID as an outpatient. Evaluated by neurology.  No further inpatient work-up.  Mental status is back to baseline.  Discharged home in stable condition.       Obesity Dietary modifications as outpatient   Covid-19 Virus Infection Date of onset of symptoms: 11/16/23 Symptoms present on admission: Malaise, subjective fevers/chills Date of covid positive test: Home test (11/17/23); confirmed on 11/23/23 (hospital). Vaccination status: unknown Imaging: CXR without acute gross abnormalities Oxygen requirements on admission: None Medical therapy: not indicated Consultants following: None Isolation can be discontinued after discharge Hypertension: Normotensive on admission. Resume home regimen     DM type II: On Lantus and SSI, continue the same     Depression: Associated with ADHD. Restart home regimen.
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Magnetic resonance imaging head normal, Malaise, Meningitis aseptic, Mental status changes, Obesity
Clinical narrative: Patient is a 53 y.o. male patient of MD with history of depression, hypertension, DM type II presented to Hospital with altered mental status and fever  Assessment and Plan   Acute febrile illness Altered mental status Febrile for 10 days PTA along with headache and chills Not associated with other gross neurological deficits or meningismus. Afebrile on presentation; hemodynamically stable. No meningeal signs CT brain w/o acute gross abnormalities.  In setting of recent viral infection, lumbar puncture was performed in the ED  Empirically received IV vancomycin, ceftriaxone, acyclovir, dexamethasone LP findings reviewed, Increased white count at 11 with lymphocytosis in CSF CSF PCR negative. Discussed with ID Dr,  DCd acyclovir and ampicillin given HSV and Listeria PCR negative on11/23 Received phone call from patient's PCP Dr, patient has multiple sexual partners, ordered CSF VDRL, syphilis antibody, HIV testing Patient had history of for possible syphilis, treated with penicillin a year ago.  Syphilis antibody positive because of previous history MRI findings- no new stroke, chronic white matter changes related to due trauma/inflammation/demyelination, or chronic ischemia associated with migraine/atherosclerosis. ID consulted for concern for possible neurosyphilis.  Consult appreciated suspected LP findings probably secondary to aseptic meningitis/COVID meningitis MRI changes related to recent COVID infection.  Recommended to stop antibiotics.  His presentation does not correspond to neurosyphilis as per ID.  Recommended possible repeat lumbar puncture in 2 months to completely rule out neurosyphilis.  Patient to follow-up with ID as an outpatient. Evaluated by neurology.  No further inpatient work-up.  Mental status is back to baseline.  Discharged home in stable condition.       Obesity Dietary modifications as outpatient   Covid-19 Virus Infection Date of onset of symptoms: 11/16/23 Symptoms present on admission: Malaise, subjective fevers/chills Date of covid positive test: Home test (11/17/23); confirmed on 11/23/23 (hospital). Vaccination status: unknown Imaging: CXR without acute gross abnormalities Oxygen requirements on admission: None Medical therapy: not indicated Consultants following: None Isolation can be discontinued after discharge Hypertension: Normotensive on admission. Resume home regimen     DM type II: On Lantus and SSI, continue the same     Depression: Associated with ADHD. Restart home regimen.
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Polymerase chain reaction negative, Pyrexia, SARS-CoV-2 test positive, Treponema test, Treponema test positive
Clinical narrative: Patient is a 53 y.o. male patient of MD with history of depression, hypertension, DM type II presented to Hospital with altered mental status and fever  Assessment and Plan   Acute febrile illness Altered mental status Febrile for 10 days PTA along with headache and chills Not associated with other gross neurological deficits or meningismus. Afebrile on presentation; hemodynamically stable. No meningeal signs CT brain w/o acute gross abnormalities.  In setting of recent viral infection, lumbar puncture was performed in the ED  Empirically received IV vancomycin, ceftriaxone, acyclovir, dexamethasone LP findings reviewed, Increased white count at 11 with lymphocytosis in CSF CSF PCR negative. Discussed with ID Dr,  DCd acyclovir and ampicillin given HSV and Listeria PCR negative on11/23 Received phone call from patient's PCP Dr, patient has multiple sexual partners, ordered CSF VDRL, syphilis antibody, HIV testing Patient had history of for possible syphilis, treated with penicillin a year ago.  Syphilis antibody positive because of previous history MRI findings- no new stroke, chronic white matter changes related to due trauma/inflammation/demyelination, or chronic ischemia associated with migraine/atherosclerosis. ID consulted for concern for possible neurosyphilis.  Consult appreciated suspected LP findings probably secondary to aseptic meningitis/COVID meningitis MRI changes related to recent COVID infection.  Recommended to stop antibiotics.  His presentation does not correspond to neurosyphilis as per ID.  Recommended possible repeat lumbar puncture in 2 months to completely rule out neurosyphilis.  Patient to follow-up with ID as an outpatient. Evaluated by neurology.  No further inpatient work-up.  Mental status is back to baseline.  Discharged home in stable condition.       Obesity Dietary modifications as outpatient   Covid-19 Virus Infection Date of onset of symptoms: 11/16/23 Symptoms present on admission: Malaise, subjective fevers/chills Date of covid positive test: Home test (11/17/23); confirmed on 11/23/23 (hospital). Vaccination status: unknown Imaging: CXR without acute gross abnormalities Oxygen requirements on admission: None Medical therapy: not indicated Consultants following: None Isolation can be discontinued after discharge Hypertension: Normotensive on admission. Resume home regimen     DM type II: On Lantus and SSI, continue the same     Depression: Associated with ADHD. Restart home regimen.
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Viral infection
Clinical narrative: Patient is a 53 y.o. male patient of MD with history of depression, hypertension, DM type II presented to Hospital with altered mental status and fever  Assessment and Plan   Acute febrile illness Altered mental status Febrile for 10 days PTA along with headache and chills Not associated with other gross neurological deficits or meningismus. Afebrile on presentation; hemodynamically stable. No meningeal signs CT brain w/o acute gross abnormalities.  In setting of recent viral infection, lumbar puncture was performed in the ED  Empirically received IV vancomycin, ceftriaxone, acyclovir, dexamethasone LP findings reviewed, Increased white count at 11 with lymphocytosis in CSF CSF PCR negative. Discussed with ID Dr,  DCd acyclovir and ampicillin given HSV and Listeria PCR negative on11/23 Received phone call from patient's PCP Dr, patient has multiple sexual partners, ordered CSF VDRL, syphilis antibody, HIV testing Patient had history of for possible syphilis, treated with penicillin a year ago.  Syphilis antibody positive because of previous history MRI findings- no new stroke, chronic white matter changes related to due trauma/inflammation/demyelination, or chronic ischemia associated with migraine/atherosclerosis. ID consulted for concern for possible neurosyphilis.  Consult appreciated suspected LP findings probably secondary to aseptic meningitis/COVID meningitis MRI changes related to recent COVID infection.  Recommended to stop antibiotics.  His presentation does not correspond to neurosyphilis as per ID.  Recommended possible repeat lumbar puncture in 2 months to completely rule out neurosyphilis.  Patient to follow-up with ID as an outpatient. Evaluated by neurology.  No further inpatient work-up.  Mental status is back to baseline.  Discharged home in stable condition.       Obesity Dietary modifications as outpatient   Covid-19 Virus Infection Date of onset of symptoms: 11/16/23 Symptoms present on admission: Malaise, subjective fevers/chills Date of covid positive test: Home test (11/17/23); confirmed on 11/23/23 (hospital). Vaccination status: unknown Imaging: CXR without acute gross abnormalities Oxygen requirements on admission: None Medical therapy: not indicated Consultants following: None Isolation can be discontinued after discharge Hypertension: Normotensive on admission. Resume home regimen     DM type II: On Lantus and SSI, continue the same     Depression: Associated with ADHD. Restart home regimen.
Age: 55.0
Sex: M
Vaccine: VARZOS, VARZOS
Symptoms: Unevaluable event
Clinical narrative: Vaccine Refridgerated
Age: 1.25
Sex: F
Vaccine: COVID19
Symptoms: No adverse event
Clinical narrative: None stated
Age: 52.0
Sex: F
Vaccine: COVID19
Symptoms: Chest pain, Dyspnoea, Pain in extremity, Respiratory tract congestion
Clinical narrative: shortness of breath, chest pain, arm pain, head clogged up
Age: 57.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Unevaluable event
Clinical narrative: Vaccine Refridgerated
Age: 82.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Asthenia, Blood culture, Blood lactic acid normal, COVID-19
Clinical narrative: Patient is a 83 y.o. male patient of MD with history of Melanoma, hyperthyroidism, C.Diff, HTN, IBS, WPW, LBBB, Prostate CA s/p RT, radiation proctitis presented to Medical Center with fever and weakness .     Acute hypoxemic resp failure - resolved COVID-19  Date of onset of symptoms: ~11/12 Symptoms present on admission: fever; weakness Date of covid positive test: 11/13 Vaccination status: vaccinated ICXR unremarkable on admission Oxygen requirements on admission: 3L Current oxygen requirements: 3L Medical therapy: Steroids and Remdesivir Consultants following: none Anticipated special isolation end date: tentatively 11/21   11/16: Patient currently on room air. Started Remdesvir 11/14, currently on day 3 of 4 but requesting discharge at this time stating his symptoms have resolved and breathing is back to baseline. Patient informed if discharged he would miss final dose to which he stated he understood and would like to go home. Patient to follow up with PCP upon hospital discharge. Will discharge on Decadron for a total of 10 days.    Sepsis POA with fever and resp failure Likely viral due to COVID WBC and lactate wnl Hemodynamically stable  CXR unremarkable  BCx ordered  Holding off ABx for now   HTN Cont home Norvasc, Cozaar, BB with holding parameters    Chronic proctitis Currently stable Cont home Canasa
Age: 82.0
Sex: M
Vaccine: COVID19-2
Symptoms: Chest X-ray normal, Pyrexia, SARS-CoV-2 test positive, Sepsis, White blood cell count normal
Clinical narrative: Patient is a 83 y.o. male patient of MD with history of Melanoma, hyperthyroidism, C.Diff, HTN, IBS, WPW, LBBB, Prostate CA s/p RT, radiation proctitis presented to Medical Center with fever and weakness .     Acute hypoxemic resp failure - resolved COVID-19  Date of onset of symptoms: ~11/12 Symptoms present on admission: fever; weakness Date of covid positive test: 11/13 Vaccination status: vaccinated ICXR unremarkable on admission Oxygen requirements on admission: 3L Current oxygen requirements: 3L Medical therapy: Steroids and Remdesivir Consultants following: none Anticipated special isolation end date: tentatively 11/21   11/16: Patient currently on room air. Started Remdesvir 11/14, currently on day 3 of 4 but requesting discharge at this time stating his symptoms have resolved and breathing is back to baseline. Patient informed if discharged he would miss final dose to which he stated he understood and would like to go home. Patient to follow up with PCP upon hospital discharge. Will discharge on Decadron for a total of 10 days.    Sepsis POA with fever and resp failure Likely viral due to COVID WBC and lactate wnl Hemodynamically stable  CXR unremarkable  BCx ordered  Holding off ABx for now   HTN Cont home Norvasc, Cozaar, BB with holding parameters    Chronic proctitis Currently stable Cont home Canasa
Age: 61.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Unevaluable event
Clinical narrative: Vaccine Refridgerated
Age: 57.0
Sex: M
Vaccine: RSV
Symptoms: No adverse event, Product administered to patient of inappropriate age
Clinical narrative: No Adverse event to report. Vaccine administered at 57 years 11 months using clinical judgement due to risk conditions.
Age: 63.0
Sex: F
Vaccine: FLUC4
Symptoms: Cough, Diarrhoea, Feeling abnormal, Lip swelling, Malaise
Clinical narrative: I was feeling sick on the 22nd. In the middle of the night into the 23rd I had diarrhea and when I woke up I vomited 3 times. On the 24th I had a little cough and diarrhea. On the 25th I just wasn't feeling right. I took Nyquil and Dayquil in the days following. On the 27th I had some hives and splotchy marks on my face and neck that were warm.  I took a Benadryl.  On the 28th I had hives that covered the front of my torso in the morning and in the afternoon it was on my back and low back area and the hives on the torso were gone. Then over night into the 29th The hives had moved down my legs and into my feet. I have developed a swollen top lip this morning and then by afternoon it moved into my shoulders. It left my feet and is now in my shoulders, neck, and face. The morning of the 29th it felt like my feet were swollen as well. I have been taking Benadryl. I woke up from a long nap and the hives were all gone around 3:45pm today.
Age: 63.0
Sex: F
Vaccine: FLUC4
Symptoms: Rash macular, Skin warm, Swelling, Urticaria, Vomiting
Clinical narrative: I was feeling sick on the 22nd. In the middle of the night into the 23rd I had diarrhea and when I woke up I vomited 3 times. On the 24th I had a little cough and diarrhea. On the 25th I just wasn't feeling right. I took Nyquil and Dayquil in the days following. On the 27th I had some hives and splotchy marks on my face and neck that were warm.  I took a Benadryl.  On the 28th I had hives that covered the front of my torso in the morning and in the afternoon it was on my back and low back area and the hives on the torso were gone. Then over night into the 29th The hives had moved down my legs and into my feet. I have developed a swollen top lip this morning and then by afternoon it moved into my shoulders. It left my feet and is now in my shoulders, neck, and face. The morning of the 29th it felt like my feet were swollen as well. I have been taking Benadryl. I woke up from a long nap and the hives were all gone around 3:45pm today.
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Ammonia, Anaemia, Arthralgia
Clinical narrative: Patient is an 80 year old gentleman with a past medical history of Parkinson's disease and dementia, T2DM, hypertension, lower extremity edema, impaired mobility, falls, BPH, OSA who has been admitted to Hospital 11/9/2023 with weakness and lethargy, COVID-19 infection.   Sepsis Possible aspiration pneumonia Present on admission: no Etiology: Unclear etiology, possible aspiration pneumonia SIRS criteria: Temperature greater than 100.4 or less than 96.8, Heart rate greater than 90 Cautious IV fluids due to volume status. Check blood and urine cultures Check x-ray of the chest showed new bibasilar infiltrates. Lactic acid 1.0 Start vancomycin and Zosyn Obtain CT brain due to worsening encephalopathy Check CBC, CMP, and ammonia Mental status back to baseline, continue course of antibiotics on discharge Patient stable for discharge with close outpatient follow-up   Acute metabolic encephalopathy, improving Weakness Lethargy Falls History of dementia and Parkinson's, see below; acute encephalopathy likely exacerbated by COVID-19 PT/OT/CM following We will need SNF placement     Acute hypoxemic respiratory failure, now resolved Covid-19 Virus Infection, resolved Possible covid Encephalopathy  Date of onset of symptoms: 11/7/2023  Date of covid positive test: 11/9/2023 Vaccination status: vaccinated Imaging: CXR 11/9 no acute findings Medical therapy: Remdesivir, finishing 11/13; IV steroids.  Discontinue steroids since he is on room air BNP was elevated at 1351, s/p IV diuresis Symptoms of COVID resolved and the patient can come out of isolation Mechanical Fall  Low back pain  Knee pain  Images reviewed , no fracture or dislocation Pain control  Avoid narcotics given the patient's altered mental status PRN Tylenol PT/OT   Acute kidney injury, resolved Baseline Cr appears to be ~0.8-1 Of note patient did receive IV diuresis on admission, now stopped Holding losartan as below   Hypertension Elevated blood pressure on admission Holding losartan due to AKI.  Can resume on discharge and will need to follow-up kidney functions as an outpatient. Hydralazine 10 mg IV as needed every 6 hours for elevated blood pressure BP well controlled at this time   Parkinsonism Dementia Continue carbidopa levodopa, donepezil   Dysphagia Noted per SLP evaluation Follow dietary recommendations   NIDDM2 Diet controlled Keep BG between 140 and 180 Last A1c x3 less than 6   BPH Tamsulosin Foley Anemia Continue to monitor Outpatient evaluation and management
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Asthenia, Back pain, Bladder catheterisation, Blood creatinine normal, Blood culture
Clinical narrative: Patient is an 80 year old gentleman with a past medical history of Parkinson's disease and dementia, T2DM, hypertension, lower extremity edema, impaired mobility, falls, BPH, OSA who has been admitted to Hospital 11/9/2023 with weakness and lethargy, COVID-19 infection.   Sepsis Possible aspiration pneumonia Present on admission: no Etiology: Unclear etiology, possible aspiration pneumonia SIRS criteria: Temperature greater than 100.4 or less than 96.8, Heart rate greater than 90 Cautious IV fluids due to volume status. Check blood and urine cultures Check x-ray of the chest showed new bibasilar infiltrates. Lactic acid 1.0 Start vancomycin and Zosyn Obtain CT brain due to worsening encephalopathy Check CBC, CMP, and ammonia Mental status back to baseline, continue course of antibiotics on discharge Patient stable for discharge with close outpatient follow-up   Acute metabolic encephalopathy, improving Weakness Lethargy Falls History of dementia and Parkinson's, see below; acute encephalopathy likely exacerbated by COVID-19 PT/OT/CM following We will need SNF placement     Acute hypoxemic respiratory failure, now resolved Covid-19 Virus Infection, resolved Possible covid Encephalopathy  Date of onset of symptoms: 11/7/2023  Date of covid positive test: 11/9/2023 Vaccination status: vaccinated Imaging: CXR 11/9 no acute findings Medical therapy: Remdesivir, finishing 11/13; IV steroids.  Discontinue steroids since he is on room air BNP was elevated at 1351, s/p IV diuresis Symptoms of COVID resolved and the patient can come out of isolation Mechanical Fall  Low back pain  Knee pain  Images reviewed , no fracture or dislocation Pain control  Avoid narcotics given the patient's altered mental status PRN Tylenol PT/OT   Acute kidney injury, resolved Baseline Cr appears to be ~0.8-1 Of note patient did receive IV diuresis on admission, now stopped Holding losartan as below   Hypertension Elevated blood pressure on admission Holding losartan due to AKI.  Can resume on discharge and will need to follow-up kidney functions as an outpatient. Hydralazine 10 mg IV as needed every 6 hours for elevated blood pressure BP well controlled at this time   Parkinsonism Dementia Continue carbidopa levodopa, donepezil   Dysphagia Noted per SLP evaluation Follow dietary recommendations   NIDDM2 Diet controlled Keep BG between 140 and 180 Last A1c x3 less than 6   BPH Tamsulosin Foley Anemia Continue to monitor Outpatient evaluation and management