chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 57.0
Sex: M
Vaccine: COVID19
Symptoms: Stool analysis normal, Systemic inflammatory response syndrome, Treatment noncompliance, Troponin increased, White blood cell count normal
Clinical narrative: Patient is a 58 y.o. male with a history of pancreatic cancer, IDDM2, seizure disorder, recent hospital admit 11/27/22-12/1/22 for planned surgery (s/p exploratory laparotomy, partial hepatectomy, CCY and omental flap on 11/28/22) by Dr. (surgical onc.) who re-presented to hospital 12/4/2022 with congestion, dyspnea, dry cough, fevers/chills, lethargy, and hypoxia after recent diagnosis of COVID-19 on 12/3/22.    1. COVID-19: Presented as above. Symptom onset ~12/1/22, tested positive on 12/3/22, vaccinated and boosted x 1. CTPA 12/4/22 negative for PE, stable b/l pulmonary nodules, mild bibasilar atelectasis. Supportive care, symptom control, Decadron and Remdesivir initiated 12/5/22. Clinically improved.discharged on decadron till 12/13/2022. 2. Acute Hypoxic Respiratory Failure: In setting of COVID-19. SpO2 85-90% on RA at home with improvement on 2L NC. Improved to RA on 12/6/22. 3. SIRS: Met criteria with HR and RR elevated, though afebrile/WBC and lactate WNL. In setting of COVID-19 and respiratory failure. Blood cultures x 2 negative to date .  4. AKI: Baseline Cr ~1.0, admit Cr 1.48. Suspect pre-renal due to hypovolemia. Avoid nephrotoxic medications as able. Held home ACEi. Resolved. Lisinopril resumed in low dose on discharge. 5. Diarrhea: Watery and malodorous, recently given Ancef peri-op last admit. Held bowel regimen. Stool PCR 12/4 neg. Resolved. 6. Elevated Troponin: Admit troponin 43-41. No anginal symptoms on admit. EKG non-ischemic, similar to prior. Suspect due to demand/decreased renal clearance. No further workup at this time.  7. Pancreatic Adenocarcinoma: Known hx, follows with Dr. (Surgical Onc) and Dr. (Med Onc). On FOLFIRINOX as outpatient. CT C/A/P 11/17/22 with stable findings. S/p exploratory laparotomy, partial hepatectomy, CCY and omental flap on 11/28/22. Continued post-op pain control. Surgical oncology followed  8. IDDM2: Known hx, A1c 8.7% in 11/2022. Follows with Dr. (endocrinology). Home meds resumed on discharge. 9. HTN: Known hx, controlled on admit. Held home ACEi due to AKI, low dose resumed on discharge. 10. Chronic Anemia: Baseline Hgb ~11, admit Hgb 11.2, normocytic. Stable since recent surgery. No evidence of acute blood loss.  11. Seizure Disorder: Known hx, no acute issues. Continued Depakote.  12. Hypothyroidism: Known hx, continued home Synthroid.  13. BPH: Known hx, continued home Flomax.  14. Obesity with OSA: Body mass index is 35.87 kg/m². Non-compliant with CPAP, encourage use as able
Age: 56.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acoustic stimulation tests abnormal, Audiogram abnormal, Deafness neurosensory, Deafness unilateral, Dizziness
Clinical narrative: I woke up on November 26, 2022 with aural fullness and could not hear out of my right ear. I experienced vertigo/dizziness and tinnitus. I saw an ENT doctor on November 30, 2022 who diagnosed sudden sensorineural hearing loss and I was started on oral prednisone (60 mg x 4 days, 40 mg x 4 days, 20 mg x 2 days, 10 mg x 2 days). A comprehensive hearing test was performed 12/7/2022 and showed my right ear had 1) severe sloping to profound sudden sensorineural hearing loss 2) loss of ipsilateral and contralateral acoustic reflexes in my right ear and 3) no responses on speech recognition threshold. Intratympanic dexamethasone (0.4ml 24 mg/ml) was administered 12/8/2022 and 12/15/2022. Brain MRI (IAC protocol) with and without contrast was performed 12/28/22 and was normal. Prior to this, I had no history of hearing loss, tinnitus, vertigo/dizziness and had a normal annual physical on 11/2/2022.
Age: 56.0
Sex: F
Vaccine: COVID19-2
Symptoms: Ear discomfort, Magnetic resonance imaging head normal, Scan with contrast normal, Sudden hearing loss, Tinnitus
Clinical narrative: I woke up on November 26, 2022 with aural fullness and could not hear out of my right ear. I experienced vertigo/dizziness and tinnitus. I saw an ENT doctor on November 30, 2022 who diagnosed sudden sensorineural hearing loss and I was started on oral prednisone (60 mg x 4 days, 40 mg x 4 days, 20 mg x 2 days, 10 mg x 2 days). A comprehensive hearing test was performed 12/7/2022 and showed my right ear had 1) severe sloping to profound sudden sensorineural hearing loss 2) loss of ipsilateral and contralateral acoustic reflexes in my right ear and 3) no responses on speech recognition threshold. Intratympanic dexamethasone (0.4ml 24 mg/ml) was administered 12/8/2022 and 12/15/2022. Brain MRI (IAC protocol) with and without contrast was performed 12/28/22 and was normal. Prior to this, I had no history of hearing loss, tinnitus, vertigo/dizziness and had a normal annual physical on 11/2/2022.
Age: 56.0
Sex: F
Vaccine: COVID19-2
Symptoms: Tympanometry abnormal, Vertigo
Clinical narrative: I woke up on November 26, 2022 with aural fullness and could not hear out of my right ear. I experienced vertigo/dizziness and tinnitus. I saw an ENT doctor on November 30, 2022 who diagnosed sudden sensorineural hearing loss and I was started on oral prednisone (60 mg x 4 days, 40 mg x 4 days, 20 mg x 2 days, 10 mg x 2 days). A comprehensive hearing test was performed 12/7/2022 and showed my right ear had 1) severe sloping to profound sudden sensorineural hearing loss 2) loss of ipsilateral and contralateral acoustic reflexes in my right ear and 3) no responses on speech recognition threshold. Intratympanic dexamethasone (0.4ml 24 mg/ml) was administered 12/8/2022 and 12/15/2022. Brain MRI (IAC protocol) with and without contrast was performed 12/28/22 and was normal. Prior to this, I had no history of hearing loss, tinnitus, vertigo/dizziness and had a normal annual physical on 11/2/2022.
Age: 38.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Given past 30 day use by date in fridge
Age: 42.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: Inadvertent administration past the 30-day Use by Date of the Moderna vaccine. No Symptoms to report as no adverse event was reported.
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Malaise, Pain in extremity, SARS-CoV-2 test
Clinical narrative: slightly sore arm general malaise both for 24 hours
Age: 60.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Given past 30 day use by date in fridge
Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Atelectasis, COVID-19, Chest X-ray abnormal, Computerised tomogram thorax abnormal
Clinical narrative: Patient is a 77 y.o. female with a history of HTN, osteoporosis, idiopathic gastroparesis who presented to emergency 11/26/2022 for rib pain without a fall or injuries. Found to have multiple acute bilateral rib fractures so she was transferred to ED for trauma evaluation. Urgent Care following since admission for medical management. Hospital course complicated by diagnosis of COVID-19, acute hypoxic respiratory failure and hypotension.   1. Multiple bilateral acute rib fractures started 1 day before admission, after being hugged by a friend. In setting of known osteoporosis . CT chest 11/26/2022 found anterior to anterolateral right 3-7 and left 4-7 rib fractures, grade 2 chest wall injury. Aggressive pulmonary toilet with I-S and vibratory PEEP.  Pain control. PT/OT followed. Trauma followed, f/u OP 12/15 in trauma clinic. 2. COVID-19: Vaccinated. Developed sore throat and test positive 11/29/22. CXR 11/29/22 with minimal bibasilar atelectasis, no consolidations. Initially without cough or sputum production but developed symptoms on 11/30/22 with hypoxia. Completed 6 days of dexamethasone with improvement to room air. Completed isolation. 3. Acute hypoxic respiratory failure: required 2L NC 11/30/22 AM.  Secondary to COVID-19 infection, rib fracture. Resolved 4. Osteoporosis: known h/o, likely directly contributed to fx above. Continued home vitamin D, calcium and Fosamax.  5. Solitary pulmonary nodule: noted incidentally on admit imaging with new 0.5cm cavitary nodule or cystic lesions with smooth wall thickening in RUL consider traumatic vs inflammatory vs neoplastic etiologies. Extensive secondhand smoke exposure. Outpatient follow up imaging per Organization at 1 year. 6. Incidental findings: noted questionable filling defect in CBD with no intra nor extrahepatic biliary lesion. Consider MRCP if were to develop symptoms of biliary colic. Also noted unchanged distal splenic artery aneurysm measuring up to 0.8cm, repeat imaging 1 year recommended per report. 7. HTN: home meds held briefly for hypotension as above. Improved. No med changes on discharge. 8. EtOH dependence: drinks 3 beers/day. Denied any h/o EtOH withdrawal in the past. Discharged on thiamine and folate supplement. Recommended outpatient follow-up.
Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Hypotension, Hypoxia, Inflammation, Injury, Musculoskeletal chest pain
Clinical narrative: Patient is a 77 y.o. female with a history of HTN, osteoporosis, idiopathic gastroparesis who presented to emergency 11/26/2022 for rib pain without a fall or injuries. Found to have multiple acute bilateral rib fractures so she was transferred to ED for trauma evaluation. Urgent Care following since admission for medical management. Hospital course complicated by diagnosis of COVID-19, acute hypoxic respiratory failure and hypotension.   1. Multiple bilateral acute rib fractures started 1 day before admission, after being hugged by a friend. In setting of known osteoporosis . CT chest 11/26/2022 found anterior to anterolateral right 3-7 and left 4-7 rib fractures, grade 2 chest wall injury. Aggressive pulmonary toilet with I-S and vibratory PEEP.  Pain control. PT/OT followed. Trauma followed, f/u OP 12/15 in trauma clinic. 2. COVID-19: Vaccinated. Developed sore throat and test positive 11/29/22. CXR 11/29/22 with minimal bibasilar atelectasis, no consolidations. Initially without cough or sputum production but developed symptoms on 11/30/22 with hypoxia. Completed 6 days of dexamethasone with improvement to room air. Completed isolation. 3. Acute hypoxic respiratory failure: required 2L NC 11/30/22 AM.  Secondary to COVID-19 infection, rib fracture. Resolved 4. Osteoporosis: known h/o, likely directly contributed to fx above. Continued home vitamin D, calcium and Fosamax.  5. Solitary pulmonary nodule: noted incidentally on admit imaging with new 0.5cm cavitary nodule or cystic lesions with smooth wall thickening in RUL consider traumatic vs inflammatory vs neoplastic etiologies. Extensive secondhand smoke exposure. Outpatient follow up imaging per Organization at 1 year. 6. Incidental findings: noted questionable filling defect in CBD with no intra nor extrahepatic biliary lesion. Consider MRCP if were to develop symptoms of biliary colic. Also noted unchanged distal splenic artery aneurysm measuring up to 0.8cm, repeat imaging 1 year recommended per report. 7. HTN: home meds held briefly for hypotension as above. Improved. No med changes on discharge. 8. EtOH dependence: drinks 3 beers/day. Denied any h/o EtOH withdrawal in the past. Discharged on thiamine and folate supplement. Recommended outpatient follow-up.
Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Neoplasm, Oropharyngeal pain, Passive smoking, Positive end-expiratory pressure, Productive cough
Clinical narrative: Patient is a 77 y.o. female with a history of HTN, osteoporosis, idiopathic gastroparesis who presented to emergency 11/26/2022 for rib pain without a fall or injuries. Found to have multiple acute bilateral rib fractures so she was transferred to ED for trauma evaluation. Urgent Care following since admission for medical management. Hospital course complicated by diagnosis of COVID-19, acute hypoxic respiratory failure and hypotension.   1. Multiple bilateral acute rib fractures started 1 day before admission, after being hugged by a friend. In setting of known osteoporosis . CT chest 11/26/2022 found anterior to anterolateral right 3-7 and left 4-7 rib fractures, grade 2 chest wall injury. Aggressive pulmonary toilet with I-S and vibratory PEEP.  Pain control. PT/OT followed. Trauma followed, f/u OP 12/15 in trauma clinic. 2. COVID-19: Vaccinated. Developed sore throat and test positive 11/29/22. CXR 11/29/22 with minimal bibasilar atelectasis, no consolidations. Initially without cough or sputum production but developed symptoms on 11/30/22 with hypoxia. Completed 6 days of dexamethasone with improvement to room air. Completed isolation. 3. Acute hypoxic respiratory failure: required 2L NC 11/30/22 AM.  Secondary to COVID-19 infection, rib fracture. Resolved 4. Osteoporosis: known h/o, likely directly contributed to fx above. Continued home vitamin D, calcium and Fosamax.  5. Solitary pulmonary nodule: noted incidentally on admit imaging with new 0.5cm cavitary nodule or cystic lesions with smooth wall thickening in RUL consider traumatic vs inflammatory vs neoplastic etiologies. Extensive secondhand smoke exposure. Outpatient follow up imaging per Organization at 1 year. 6. Incidental findings: noted questionable filling defect in CBD with no intra nor extrahepatic biliary lesion. Consider MRCP if were to develop symptoms of biliary colic. Also noted unchanged distal splenic artery aneurysm measuring up to 0.8cm, repeat imaging 1 year recommended per report. 7. HTN: home meds held briefly for hypotension as above. Improved. No med changes on discharge. 8. EtOH dependence: drinks 3 beers/day. Denied any h/o EtOH withdrawal in the past. Discharged on thiamine and folate supplement. Recommended outpatient follow-up.
Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Pulmonary mass, Rib fracture, SARS-CoV-2 test positive, Splenic artery aneurysm
Clinical narrative: Patient is a 77 y.o. female with a history of HTN, osteoporosis, idiopathic gastroparesis who presented to emergency 11/26/2022 for rib pain without a fall or injuries. Found to have multiple acute bilateral rib fractures so she was transferred to ED for trauma evaluation. Urgent Care following since admission for medical management. Hospital course complicated by diagnosis of COVID-19, acute hypoxic respiratory failure and hypotension.   1. Multiple bilateral acute rib fractures started 1 day before admission, after being hugged by a friend. In setting of known osteoporosis . CT chest 11/26/2022 found anterior to anterolateral right 3-7 and left 4-7 rib fractures, grade 2 chest wall injury. Aggressive pulmonary toilet with I-S and vibratory PEEP.  Pain control. PT/OT followed. Trauma followed, f/u OP 12/15 in trauma clinic. 2. COVID-19: Vaccinated. Developed sore throat and test positive 11/29/22. CXR 11/29/22 with minimal bibasilar atelectasis, no consolidations. Initially without cough or sputum production but developed symptoms on 11/30/22 with hypoxia. Completed 6 days of dexamethasone with improvement to room air. Completed isolation. 3. Acute hypoxic respiratory failure: required 2L NC 11/30/22 AM.  Secondary to COVID-19 infection, rib fracture. Resolved 4. Osteoporosis: known h/o, likely directly contributed to fx above. Continued home vitamin D, calcium and Fosamax.  5. Solitary pulmonary nodule: noted incidentally on admit imaging with new 0.5cm cavitary nodule or cystic lesions with smooth wall thickening in RUL consider traumatic vs inflammatory vs neoplastic etiologies. Extensive secondhand smoke exposure. Outpatient follow up imaging per Organization at 1 year. 6. Incidental findings: noted questionable filling defect in CBD with no intra nor extrahepatic biliary lesion. Consider MRCP if were to develop symptoms of biliary colic. Also noted unchanged distal splenic artery aneurysm measuring up to 0.8cm, repeat imaging 1 year recommended per report. 7. HTN: home meds held briefly for hypotension as above. Improved. No med changes on discharge. 8. EtOH dependence: drinks 3 beers/day. Denied any h/o EtOH withdrawal in the past. Discharged on thiamine and folate supplement. Recommended outpatient follow-up.
Age: 84.0
Sex: F
Vaccine: COVID19
Symptoms: Anticoagulant therapy, Asthenia, Blood creatinine increased, Blood fibrinogen normal, Blood lactate dehydrogenase increased
Clinical narrative: Patient is a 86 y.o. female patient of MD with history of HTN, DM, hypothyroidism, CKD  presented to a local Hospital with weakness and  sob.    COVID-19 Infection Generalized weakness Vaccinated without booster Symptoms onset 11/25/22, positive test date 11/29/22 No current oxygen demand  Trend inflammatory markers - CRP 3.4 LDH 386 Fibrinogen 385 D-dimer 1.85 MAB: Not indicated Steroids: Not indicated Anticoagulation: Heparin Consider discontinuation of isolation 12/8/22  Consult PT/OT - recommends skilled therapy  Consult case management - discharge needs    Stage 3b CKD Historical baseline: Cr 1.7 & GFR 32 Cr 1.78 Renally dose medications and avoid nephrotoxins   DM2 Resume home medications    Hypokalemia - resolved  2.8 on presentation Replace and recheck    Hypothyroidism  Continue supplement     HTN  SBP >200 in the ED  Restart home medication - stopped meds several days ago due to not feeling well Prn hydralazine  SBP 150s-  change metoprolol to coreg 12.5mg BID to achieve better BP control  Follow up with PCP    Elevated trop in setting of COVID 19   Initial troponin 89 Repeat troponin 80 EKG NSR  NT proBNP 4610 STT 2020 NLVFX EF 74% possible small mild area of ischemia the inferolateral segment. Medically managed
Age: 84.0
Sex: F
Vaccine: COVID19
Symptoms: Blood potassium decreased, C-reactive protein increased, COVID-19, Dyspnoea, Ejection fraction normal
Clinical narrative: Patient is a 86 y.o. female patient of MD with history of HTN, DM, hypothyroidism, CKD  presented to a local Hospital with weakness and  sob.    COVID-19 Infection Generalized weakness Vaccinated without booster Symptoms onset 11/25/22, positive test date 11/29/22 No current oxygen demand  Trend inflammatory markers - CRP 3.4 LDH 386 Fibrinogen 385 D-dimer 1.85 MAB: Not indicated Steroids: Not indicated Anticoagulation: Heparin Consider discontinuation of isolation 12/8/22  Consult PT/OT - recommends skilled therapy  Consult case management - discharge needs    Stage 3b CKD Historical baseline: Cr 1.7 & GFR 32 Cr 1.78 Renally dose medications and avoid nephrotoxins   DM2 Resume home medications    Hypokalemia - resolved  2.8 on presentation Replace and recheck    Hypothyroidism  Continue supplement     HTN  SBP >200 in the ED  Restart home medication - stopped meds several days ago due to not feeling well Prn hydralazine  SBP 150s-  change metoprolol to coreg 12.5mg BID to achieve better BP control  Follow up with PCP    Elevated trop in setting of COVID 19   Initial troponin 89 Repeat troponin 80 EKG NSR  NT proBNP 4610 STT 2020 NLVFX EF 74% possible small mild area of ischemia the inferolateral segment. Medically managed
Age: 84.0
Sex: F
Vaccine: COVID19
Symptoms: Electrocardiogram normal, Fibrin D dimer, Glomerular filtration rate decreased, Hypokalaemia, Inflammatory marker test
Clinical narrative: Patient is a 86 y.o. female patient of MD with history of HTN, DM, hypothyroidism, CKD  presented to a local Hospital with weakness and  sob.    COVID-19 Infection Generalized weakness Vaccinated without booster Symptoms onset 11/25/22, positive test date 11/29/22 No current oxygen demand  Trend inflammatory markers - CRP 3.4 LDH 386 Fibrinogen 385 D-dimer 1.85 MAB: Not indicated Steroids: Not indicated Anticoagulation: Heparin Consider discontinuation of isolation 12/8/22  Consult PT/OT - recommends skilled therapy  Consult case management - discharge needs    Stage 3b CKD Historical baseline: Cr 1.7 & GFR 32 Cr 1.78 Renally dose medications and avoid nephrotoxins   DM2 Resume home medications    Hypokalemia - resolved  2.8 on presentation Replace and recheck    Hypothyroidism  Continue supplement     HTN  SBP >200 in the ED  Restart home medication - stopped meds several days ago due to not feeling well Prn hydralazine  SBP 150s-  change metoprolol to coreg 12.5mg BID to achieve better BP control  Follow up with PCP    Elevated trop in setting of COVID 19   Initial troponin 89 Repeat troponin 80 EKG NSR  NT proBNP 4610 STT 2020 NLVFX EF 74% possible small mild area of ischemia the inferolateral segment. Medically managed
Age: 84.0
Sex: F
Vaccine: COVID19
Symptoms: Malaise, N-terminal prohormone brain natriuretic peptide increased, SARS-CoV-2 test positive, Troponin increased
Clinical narrative: Patient is a 86 y.o. female patient of MD with history of HTN, DM, hypothyroidism, CKD  presented to a local Hospital with weakness and  sob.    COVID-19 Infection Generalized weakness Vaccinated without booster Symptoms onset 11/25/22, positive test date 11/29/22 No current oxygen demand  Trend inflammatory markers - CRP 3.4 LDH 386 Fibrinogen 385 D-dimer 1.85 MAB: Not indicated Steroids: Not indicated Anticoagulation: Heparin Consider discontinuation of isolation 12/8/22  Consult PT/OT - recommends skilled therapy  Consult case management - discharge needs    Stage 3b CKD Historical baseline: Cr 1.7 & GFR 32 Cr 1.78 Renally dose medications and avoid nephrotoxins   DM2 Resume home medications    Hypokalemia - resolved  2.8 on presentation Replace and recheck    Hypothyroidism  Continue supplement     HTN  SBP >200 in the ED  Restart home medication - stopped meds several days ago due to not feeling well Prn hydralazine  SBP 150s-  change metoprolol to coreg 12.5mg BID to achieve better BP control  Follow up with PCP    Elevated trop in setting of COVID 19   Initial troponin 89 Repeat troponin 80 EKG NSR  NT proBNP 4610 STT 2020 NLVFX EF 74% possible small mild area of ischemia the inferolateral segment. Medically managed
Age: 53.0
Sex: M
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: Inadvertent administration past the 30-day Use by Date of the Moderna vaccine. No Symptoms to report as no adverse event was reported.
Age: 44.0
Sex: M
Vaccine: COVID19-2, HEPA, JEV1, MMR, TYP
Symptoms: Dizziness, Immediate post-injection reaction, Loss of consciousness
Clinical narrative: Patient felt lightheaded immediately after receiving Japanese Encephalitis vaccine. This vaccine was the fifth and last vaccine given on 12/28/2022. Patient received vaccine at 4:07 PM and immediately felt lightheaded. Patient was seated on exam table and began to pitch his body forward. Patient was able to lay back on exam table with his feet up. Patient did not lose consciousness and continued to speak with this RN. Patient was provided with a cool compress for his forehead.  Patient remained supine for 10 minutes and then patient reported he felt better and was able to sit up and walk without experiencing any dizziness.
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Atrial fibrillation, Bacteraemia, Blood culture positive, Blood glucose increased
Clinical narrative: Patient is a 79 y.o. male patient of DO with history of ESRD, T2DM, myasthenia gravis, BPH, and Covid-19 presented to Hospital with worsening SOB.   Acute Hypoxic Respiratory Failure Severe sepsis due to pneumonia  Covid-19 Pneumonia Presented with four day hx of worsening SOB, cough, and intermittent chest pain Afebrile on arrival, HR 110, RR 30s, BP 160s/70, satting 94% on BiPAP Troponin negative x2 (26 => 36), D-Dimer 2.57 Initial CBC with WBC 0.83. Lactate 10.7.  CXR - multifocal pneumonia, CT Pulm arteries: multifocal airspace consolidation in all lobes. No PE. Cirrhotic morphology of the liver with findings of portal hypertension in the imaged upper abdomen Started on empiric antibiotics with vancomycin and zosyn MRSA nares pending Was empirically started on anti-fungals by eICU. ID and CC consulted, recommend holding on antifungals currently Started on decadron as COVID-19 + as well as remdesivir per ID recommendations as approx 5 days since symptom onset and already ESRD No Tocliziumab due to concern for bacterial pneumonia LA remains elevated, suspect delayed clearance in setting of possible cirrhosis, ESRD On Vapotherm, wean oxygen as able Blood cultures with 2/2 Gram positive cocci in pairs and chains, appears to be strep pneumonia Urine culture with GNB Continue antibiotics per ID, being switched to ceftriaxone Code status now updated to DNRCC after discussion with CC attending However plan is to continue antibiotics, lab draws, HD and oxygen, but to not escalate above current settings Continue vapotherm, wean as able, no bipap, no intubation, no NRB Patient moved out of ICU Patient expired morning of 12/2   New Onset A.fib with RVR Started on cardizem drip due to a.fib with RVR Cardiology consulted Appears to have converted to NSR, started on PO cardizem Echo with normal EF and questionable wall motion abnormality  Pancytopenia Chronic thormbocytopenia WBC of 0.8 on admission, Platelet count 75K (B/L 120-150) Suspect likely due to viral illness, sepsis WBC improving, no evidence of schistocytes Continue to monitor   Delirium Patient became delirious last night Was trialed on precedex but did not tolerate it Can trial seroquel   ESRD  Hyponatremia, mild  Undergoes HD MWF Nephrology consulted for HD management   T2DM Glucose 328 on admission A1c of 6.3 On NPH 15 units BID and SSI Monitor and adjust as needed   Myasthenia gravis  Continue home medication   BPH Continue home flomax
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Blood lactic acid, Blood lactic acid increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal
Clinical narrative: Patient is a 79 y.o. male patient of DO with history of ESRD, T2DM, myasthenia gravis, BPH, and Covid-19 presented to Hospital with worsening SOB.   Acute Hypoxic Respiratory Failure Severe sepsis due to pneumonia  Covid-19 Pneumonia Presented with four day hx of worsening SOB, cough, and intermittent chest pain Afebrile on arrival, HR 110, RR 30s, BP 160s/70, satting 94% on BiPAP Troponin negative x2 (26 => 36), D-Dimer 2.57 Initial CBC with WBC 0.83. Lactate 10.7.  CXR - multifocal pneumonia, CT Pulm arteries: multifocal airspace consolidation in all lobes. No PE. Cirrhotic morphology of the liver with findings of portal hypertension in the imaged upper abdomen Started on empiric antibiotics with vancomycin and zosyn MRSA nares pending Was empirically started on anti-fungals by eICU. ID and CC consulted, recommend holding on antifungals currently Started on decadron as COVID-19 + as well as remdesivir per ID recommendations as approx 5 days since symptom onset and already ESRD No Tocliziumab due to concern for bacterial pneumonia LA remains elevated, suspect delayed clearance in setting of possible cirrhosis, ESRD On Vapotherm, wean oxygen as able Blood cultures with 2/2 Gram positive cocci in pairs and chains, appears to be strep pneumonia Urine culture with GNB Continue antibiotics per ID, being switched to ceftriaxone Code status now updated to DNRCC after discussion with CC attending However plan is to continue antibiotics, lab draws, HD and oxygen, but to not escalate above current settings Continue vapotherm, wean as able, no bipap, no intubation, no NRB Patient moved out of ICU Patient expired morning of 12/2   New Onset A.fib with RVR Started on cardizem drip due to a.fib with RVR Cardiology consulted Appears to have converted to NSR, started on PO cardizem Echo with normal EF and questionable wall motion abnormality  Pancytopenia Chronic thormbocytopenia WBC of 0.8 on admission, Platelet count 75K (B/L 120-150) Suspect likely due to viral illness, sepsis WBC improving, no evidence of schistocytes Continue to monitor   Delirium Patient became delirious last night Was trialed on precedex but did not tolerate it Can trial seroquel   ESRD  Hyponatremia, mild  Undergoes HD MWF Nephrology consulted for HD management   T2DM Glucose 328 on admission A1c of 6.3 On NPH 15 units BID and SSI Monitor and adjust as needed   Myasthenia gravis  Continue home medication   BPH Continue home flomax
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Chest pain, Computerised tomogram thorax abnormal, Cough, Culture urine positive, Death
Clinical narrative: Patient is a 79 y.o. male patient of DO with history of ESRD, T2DM, myasthenia gravis, BPH, and Covid-19 presented to Hospital with worsening SOB.   Acute Hypoxic Respiratory Failure Severe sepsis due to pneumonia  Covid-19 Pneumonia Presented with four day hx of worsening SOB, cough, and intermittent chest pain Afebrile on arrival, HR 110, RR 30s, BP 160s/70, satting 94% on BiPAP Troponin negative x2 (26 => 36), D-Dimer 2.57 Initial CBC with WBC 0.83. Lactate 10.7.  CXR - multifocal pneumonia, CT Pulm arteries: multifocal airspace consolidation in all lobes. No PE. Cirrhotic morphology of the liver with findings of portal hypertension in the imaged upper abdomen Started on empiric antibiotics with vancomycin and zosyn MRSA nares pending Was empirically started on anti-fungals by eICU. ID and CC consulted, recommend holding on antifungals currently Started on decadron as COVID-19 + as well as remdesivir per ID recommendations as approx 5 days since symptom onset and already ESRD No Tocliziumab due to concern for bacterial pneumonia LA remains elevated, suspect delayed clearance in setting of possible cirrhosis, ESRD On Vapotherm, wean oxygen as able Blood cultures with 2/2 Gram positive cocci in pairs and chains, appears to be strep pneumonia Urine culture with GNB Continue antibiotics per ID, being switched to ceftriaxone Code status now updated to DNRCC after discussion with CC attending However plan is to continue antibiotics, lab draws, HD and oxygen, but to not escalate above current settings Continue vapotherm, wean as able, no bipap, no intubation, no NRB Patient moved out of ICU Patient expired morning of 12/2   New Onset A.fib with RVR Started on cardizem drip due to a.fib with RVR Cardiology consulted Appears to have converted to NSR, started on PO cardizem Echo with normal EF and questionable wall motion abnormality  Pancytopenia Chronic thormbocytopenia WBC of 0.8 on admission, Platelet count 75K (B/L 120-150) Suspect likely due to viral illness, sepsis WBC improving, no evidence of schistocytes Continue to monitor   Delirium Patient became delirious last night Was trialed on precedex but did not tolerate it Can trial seroquel   ESRD  Hyponatremia, mild  Undergoes HD MWF Nephrology consulted for HD management   T2DM Glucose 328 on admission A1c of 6.3 On NPH 15 units BID and SSI Monitor and adjust as needed   Myasthenia gravis  Continue home medication   BPH Continue home flomax
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Delirium, Dyspnoea, Echocardiogram abnormal, Ejection fraction normal, Fibrin D dimer
Clinical narrative: Patient is a 79 y.o. male patient of DO with history of ESRD, T2DM, myasthenia gravis, BPH, and Covid-19 presented to Hospital with worsening SOB.   Acute Hypoxic Respiratory Failure Severe sepsis due to pneumonia  Covid-19 Pneumonia Presented with four day hx of worsening SOB, cough, and intermittent chest pain Afebrile on arrival, HR 110, RR 30s, BP 160s/70, satting 94% on BiPAP Troponin negative x2 (26 => 36), D-Dimer 2.57 Initial CBC with WBC 0.83. Lactate 10.7.  CXR - multifocal pneumonia, CT Pulm arteries: multifocal airspace consolidation in all lobes. No PE. Cirrhotic morphology of the liver with findings of portal hypertension in the imaged upper abdomen Started on empiric antibiotics with vancomycin and zosyn MRSA nares pending Was empirically started on anti-fungals by eICU. ID and CC consulted, recommend holding on antifungals currently Started on decadron as COVID-19 + as well as remdesivir per ID recommendations as approx 5 days since symptom onset and already ESRD No Tocliziumab due to concern for bacterial pneumonia LA remains elevated, suspect delayed clearance in setting of possible cirrhosis, ESRD On Vapotherm, wean oxygen as able Blood cultures with 2/2 Gram positive cocci in pairs and chains, appears to be strep pneumonia Urine culture with GNB Continue antibiotics per ID, being switched to ceftriaxone Code status now updated to DNRCC after discussion with CC attending However plan is to continue antibiotics, lab draws, HD and oxygen, but to not escalate above current settings Continue vapotherm, wean as able, no bipap, no intubation, no NRB Patient moved out of ICU Patient expired morning of 12/2   New Onset A.fib with RVR Started on cardizem drip due to a.fib with RVR Cardiology consulted Appears to have converted to NSR, started on PO cardizem Echo with normal EF and questionable wall motion abnormality  Pancytopenia Chronic thormbocytopenia WBC of 0.8 on admission, Platelet count 75K (B/L 120-150) Suspect likely due to viral illness, sepsis WBC improving, no evidence of schistocytes Continue to monitor   Delirium Patient became delirious last night Was trialed on precedex but did not tolerate it Can trial seroquel   ESRD  Hyponatremia, mild  Undergoes HD MWF Nephrology consulted for HD management   T2DM Glucose 328 on admission A1c of 6.3 On NPH 15 units BID and SSI Monitor and adjust as needed   Myasthenia gravis  Continue home medication   BPH Continue home flomax
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Full blood count abnormal, Gram stain positive, Hepatic cirrhosis, Intensive care, Lung consolidation
Clinical narrative: Patient is a 79 y.o. male patient of DO with history of ESRD, T2DM, myasthenia gravis, BPH, and Covid-19 presented to Hospital with worsening SOB.   Acute Hypoxic Respiratory Failure Severe sepsis due to pneumonia  Covid-19 Pneumonia Presented with four day hx of worsening SOB, cough, and intermittent chest pain Afebrile on arrival, HR 110, RR 30s, BP 160s/70, satting 94% on BiPAP Troponin negative x2 (26 => 36), D-Dimer 2.57 Initial CBC with WBC 0.83. Lactate 10.7.  CXR - multifocal pneumonia, CT Pulm arteries: multifocal airspace consolidation in all lobes. No PE. Cirrhotic morphology of the liver with findings of portal hypertension in the imaged upper abdomen Started on empiric antibiotics with vancomycin and zosyn MRSA nares pending Was empirically started on anti-fungals by eICU. ID and CC consulted, recommend holding on antifungals currently Started on decadron as COVID-19 + as well as remdesivir per ID recommendations as approx 5 days since symptom onset and already ESRD No Tocliziumab due to concern for bacterial pneumonia LA remains elevated, suspect delayed clearance in setting of possible cirrhosis, ESRD On Vapotherm, wean oxygen as able Blood cultures with 2/2 Gram positive cocci in pairs and chains, appears to be strep pneumonia Urine culture with GNB Continue antibiotics per ID, being switched to ceftriaxone Code status now updated to DNRCC after discussion with CC attending However plan is to continue antibiotics, lab draws, HD and oxygen, but to not escalate above current settings Continue vapotherm, wean as able, no bipap, no intubation, no NRB Patient moved out of ICU Patient expired morning of 12/2   New Onset A.fib with RVR Started on cardizem drip due to a.fib with RVR Cardiology consulted Appears to have converted to NSR, started on PO cardizem Echo with normal EF and questionable wall motion abnormality  Pancytopenia Chronic thormbocytopenia WBC of 0.8 on admission, Platelet count 75K (B/L 120-150) Suspect likely due to viral illness, sepsis WBC improving, no evidence of schistocytes Continue to monitor   Delirium Patient became delirious last night Was trialed on precedex but did not tolerate it Can trial seroquel   ESRD  Hyponatremia, mild  Undergoes HD MWF Nephrology consulted for HD management   T2DM Glucose 328 on admission A1c of 6.3 On NPH 15 units BID and SSI Monitor and adjust as needed   Myasthenia gravis  Continue home medication   BPH Continue home flomax
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Pancytopenia, Platelet count decreased, Pneumonia, Portal hypertension, Positive airway pressure therapy
Clinical narrative: Patient is a 79 y.o. male patient of DO with history of ESRD, T2DM, myasthenia gravis, BPH, and Covid-19 presented to Hospital with worsening SOB.   Acute Hypoxic Respiratory Failure Severe sepsis due to pneumonia  Covid-19 Pneumonia Presented with four day hx of worsening SOB, cough, and intermittent chest pain Afebrile on arrival, HR 110, RR 30s, BP 160s/70, satting 94% on BiPAP Troponin negative x2 (26 => 36), D-Dimer 2.57 Initial CBC with WBC 0.83. Lactate 10.7.  CXR - multifocal pneumonia, CT Pulm arteries: multifocal airspace consolidation in all lobes. No PE. Cirrhotic morphology of the liver with findings of portal hypertension in the imaged upper abdomen Started on empiric antibiotics with vancomycin and zosyn MRSA nares pending Was empirically started on anti-fungals by eICU. ID and CC consulted, recommend holding on antifungals currently Started on decadron as COVID-19 + as well as remdesivir per ID recommendations as approx 5 days since symptom onset and already ESRD No Tocliziumab due to concern for bacterial pneumonia LA remains elevated, suspect delayed clearance in setting of possible cirrhosis, ESRD On Vapotherm, wean oxygen as able Blood cultures with 2/2 Gram positive cocci in pairs and chains, appears to be strep pneumonia Urine culture with GNB Continue antibiotics per ID, being switched to ceftriaxone Code status now updated to DNRCC after discussion with CC attending However plan is to continue antibiotics, lab draws, HD and oxygen, but to not escalate above current settings Continue vapotherm, wean as able, no bipap, no intubation, no NRB Patient moved out of ICU Patient expired morning of 12/2   New Onset A.fib with RVR Started on cardizem drip due to a.fib with RVR Cardiology consulted Appears to have converted to NSR, started on PO cardizem Echo with normal EF and questionable wall motion abnormality  Pancytopenia Chronic thormbocytopenia WBC of 0.8 on admission, Platelet count 75K (B/L 120-150) Suspect likely due to viral illness, sepsis WBC improving, no evidence of schistocytes Continue to monitor   Delirium Patient became delirious last night Was trialed on precedex but did not tolerate it Can trial seroquel   ESRD  Hyponatremia, mild  Undergoes HD MWF Nephrology consulted for HD management   T2DM Glucose 328 on admission A1c of 6.3 On NPH 15 units BID and SSI Monitor and adjust as needed   Myasthenia gravis  Continue home medication   BPH Continue home flomax
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Sepsis, Staphylococcus test, Streptococcus test positive, Thrombocytopenia
Clinical narrative: Patient is a 79 y.o. male patient of DO with history of ESRD, T2DM, myasthenia gravis, BPH, and Covid-19 presented to Hospital with worsening SOB.   Acute Hypoxic Respiratory Failure Severe sepsis due to pneumonia  Covid-19 Pneumonia Presented with four day hx of worsening SOB, cough, and intermittent chest pain Afebrile on arrival, HR 110, RR 30s, BP 160s/70, satting 94% on BiPAP Troponin negative x2 (26 => 36), D-Dimer 2.57 Initial CBC with WBC 0.83. Lactate 10.7.  CXR - multifocal pneumonia, CT Pulm arteries: multifocal airspace consolidation in all lobes. No PE. Cirrhotic morphology of the liver with findings of portal hypertension in the imaged upper abdomen Started on empiric antibiotics with vancomycin and zosyn MRSA nares pending Was empirically started on anti-fungals by eICU. ID and CC consulted, recommend holding on antifungals currently Started on decadron as COVID-19 + as well as remdesivir per ID recommendations as approx 5 days since symptom onset and already ESRD No Tocliziumab due to concern for bacterial pneumonia LA remains elevated, suspect delayed clearance in setting of possible cirrhosis, ESRD On Vapotherm, wean oxygen as able Blood cultures with 2/2 Gram positive cocci in pairs and chains, appears to be strep pneumonia Urine culture with GNB Continue antibiotics per ID, being switched to ceftriaxone Code status now updated to DNRCC after discussion with CC attending However plan is to continue antibiotics, lab draws, HD and oxygen, but to not escalate above current settings Continue vapotherm, wean as able, no bipap, no intubation, no NRB Patient moved out of ICU Patient expired morning of 12/2   New Onset A.fib with RVR Started on cardizem drip due to a.fib with RVR Cardiology consulted Appears to have converted to NSR, started on PO cardizem Echo with normal EF and questionable wall motion abnormality  Pancytopenia Chronic thormbocytopenia WBC of 0.8 on admission, Platelet count 75K (B/L 120-150) Suspect likely due to viral illness, sepsis WBC improving, no evidence of schistocytes Continue to monitor   Delirium Patient became delirious last night Was trialed on precedex but did not tolerate it Can trial seroquel   ESRD  Hyponatremia, mild  Undergoes HD MWF Nephrology consulted for HD management   T2DM Glucose 328 on admission A1c of 6.3 On NPH 15 units BID and SSI Monitor and adjust as needed   Myasthenia gravis  Continue home medication   BPH Continue home flomax
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Troponin normal, White blood cell count decreased
Clinical narrative: Patient is a 79 y.o. male patient of DO with history of ESRD, T2DM, myasthenia gravis, BPH, and Covid-19 presented to Hospital with worsening SOB.   Acute Hypoxic Respiratory Failure Severe sepsis due to pneumonia  Covid-19 Pneumonia Presented with four day hx of worsening SOB, cough, and intermittent chest pain Afebrile on arrival, HR 110, RR 30s, BP 160s/70, satting 94% on BiPAP Troponin negative x2 (26 => 36), D-Dimer 2.57 Initial CBC with WBC 0.83. Lactate 10.7.  CXR - multifocal pneumonia, CT Pulm arteries: multifocal airspace consolidation in all lobes. No PE. Cirrhotic morphology of the liver with findings of portal hypertension in the imaged upper abdomen Started on empiric antibiotics with vancomycin and zosyn MRSA nares pending Was empirically started on anti-fungals by eICU. ID and CC consulted, recommend holding on antifungals currently Started on decadron as COVID-19 + as well as remdesivir per ID recommendations as approx 5 days since symptom onset and already ESRD No Tocliziumab due to concern for bacterial pneumonia LA remains elevated, suspect delayed clearance in setting of possible cirrhosis, ESRD On Vapotherm, wean oxygen as able Blood cultures with 2/2 Gram positive cocci in pairs and chains, appears to be strep pneumonia Urine culture with GNB Continue antibiotics per ID, being switched to ceftriaxone Code status now updated to DNRCC after discussion with CC attending However plan is to continue antibiotics, lab draws, HD and oxygen, but to not escalate above current settings Continue vapotherm, wean as able, no bipap, no intubation, no NRB Patient moved out of ICU Patient expired morning of 12/2   New Onset A.fib with RVR Started on cardizem drip due to a.fib with RVR Cardiology consulted Appears to have converted to NSR, started on PO cardizem Echo with normal EF and questionable wall motion abnormality  Pancytopenia Chronic thormbocytopenia WBC of 0.8 on admission, Platelet count 75K (B/L 120-150) Suspect likely due to viral illness, sepsis WBC improving, no evidence of schistocytes Continue to monitor   Delirium Patient became delirious last night Was trialed on precedex but did not tolerate it Can trial seroquel   ESRD  Hyponatremia, mild  Undergoes HD MWF Nephrology consulted for HD management   T2DM Glucose 328 on admission A1c of 6.3 On NPH 15 units BID and SSI Monitor and adjust as needed   Myasthenia gravis  Continue home medication   BPH Continue home flomax
Age: 72.0
Sex: M
Vaccine: VARZOS
Symptoms: Cough, Erythema, Injection site pain, Myalgia, Pain
Clinical narrative: He got his vaccine, had medium pain in the right shoulder, pain when he rolled over on the right side to sleep and when he raised his arm.  Then Friday, Saturday and Sunday noticing coughing, felt he had a fever but never had a temp higher than 99.  No sweating or perspiring, overall some body and muscle aches.  Sunday night on 12/25/22 is when he noticed a rash on both front of his thighs, both knees were the thigh join on the inside, abdomen area on both sides.  Was taking Tylenol for 3-4 days and saw that it could cause a rash as well, so he stopped taking it.  He has been checking since Sunday and it is still there, not as bad as Sunday, but is still there.  It is red, not as bright red as it was before.  He reported this to his doctor yesterday after messaging him, saw him and said that something got into his body (pretty vague about it), told him he had the Shingrix vaccine and was quiet about that.  He also told him that he had been taking Tylenol and asked if it was from the vaccine, etc.  He was told that if the rash did not go away to call him back and may send him to an allergist.    He did get the first Shingrix vaccine on 10/21/22, and did not have any reaction to that one.
Age: 72.0
Sex: M
Vaccine: VARZOS
Symptoms: Pyrexia, Rash
Clinical narrative: He got his vaccine, had medium pain in the right shoulder, pain when he rolled over on the right side to sleep and when he raised his arm.  Then Friday, Saturday and Sunday noticing coughing, felt he had a fever but never had a temp higher than 99.  No sweating or perspiring, overall some body and muscle aches.  Sunday night on 12/25/22 is when he noticed a rash on both front of his thighs, both knees were the thigh join on the inside, abdomen area on both sides.  Was taking Tylenol for 3-4 days and saw that it could cause a rash as well, so he stopped taking it.  He has been checking since Sunday and it is still there, not as bad as Sunday, but is still there.  It is red, not as bright red as it was before.  He reported this to his doctor yesterday after messaging him, saw him and said that something got into his body (pretty vague about it), told him he had the Shingrix vaccine and was quiet about that.  He also told him that he had been taking Tylenol and asked if it was from the vaccine, etc.  He was told that if the rash did not go away to call him back and may send him to an allergist.    He did get the first Shingrix vaccine on 10/21/22, and did not have any reaction to that one.
Age: 67.0
Sex: M
Vaccine: COVID19-2
Symptoms: COVID-19, Rhinorrhoea, SARS-CoV-2 test positive, Sinus congestion, Throat irritation
Clinical narrative: 12/8/2022 early morning I had a scratchy throat with sinus congestion and nasal drainage.  Later that day I had a slight fever of 99.3.  Tested positive on an At Home COVID-19 test.  12/9 Televisit with doctor.  Who advised to treat symptomatically.  12/12 patient started to feel better, symptoms greatly diminished, but had been steady until that point.  By 12/13 patient reports being back to normal.  Continued to test on At Home COVID-19 tests until 12/18 when I finally tested negative.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Cough, Headache, Malaise, Nasopharyngitis
Clinical narrative: I had flown out of state, returned on 11/21/22, started feeling ill 11/21/22. I had a fever, headache, cough, head congestion. I thought I was getting a cold but once I developed a fever, I decided to use my home COVID-19 test that came back positive. I called my doctor who prescribed PAXLOVID, I started taking it on 11/23/22, by the third day I started to feel better. I did isolate for the five days. I did get rebound COVID-19 but without fever and it was relieved with over-the-counter cold medication. It wasn't as bad as the first week.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
Clinical narrative: I had flown out of state, returned on 11/21/22, started feeling ill 11/21/22. I had a fever, headache, cough, head congestion. I thought I was getting a cold but once I developed a fever, I decided to use my home COVID-19 test that came back positive. I called my doctor who prescribed PAXLOVID, I started taking it on 11/23/22, by the third day I started to feel better. I did isolate for the five days. I did get rebound COVID-19 but without fever and it was relieved with over-the-counter cold medication. It wasn't as bad as the first week.
Age: 43.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: Inadvertent administration past the 30-day Use by Date of the Moderna vaccine. No Symptoms to report as no adverse event was reported.
Age: 11.0
Sex: F
Vaccine: COVID19-2
Symptoms: No adverse event, Wrong product administered
Clinical narrative: No adverse event, pt given incorrect vaccine
Age: 76.0
Sex: F
Vaccine: COVID19-2
Symptoms: Cough, Rhinorrhoea, SARS-CoV-2 test, Sneezing
Clinical narrative: I have a runny nose with sneezing. Horrible cough.