chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 89.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Mental status changes, SARS-CoV-2 test positive, Transfusion, Troponin abnormal
Clinical narrative: 91y.o. male referred for abnormal troponin and ECG.   He is known to our practice through management of permanent atrial fibrillation with multiple strokes during previous hospital admissions.  As noted previously, the patient is not on anticoagulation at the recommendation of his oncologist in the setting of mild dysplastic syndrome requiring serial blood transfusions, gait instability with falls, recent piriformis hematoma, and epistaxis.  He has currently been in the hospital since 7/19, currently in the inpatient rehab unit, and has only been out of the hospital for around 48 hours total ever since 6/26.  For the past few days the patient has been experiencing fluctuating mental status with significant lethargy and variable blood pressure values requiring multiple RRT calls.  Symptoms have been attributed to anemia, and the patient is now back to mental status after receiving blood transfusion.  During one of the RRT evaluations, ECG was noted to be mildly abnormal.  Follow-up troponin was minimally elevated 0.05, which then trended down.  Because the troponin elevation ECG changes, cardiology consult was requested.  The patient, confirmed by his wife, was not having any chest discomfort, dyspnea, or palpitations.
Age: 21.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Body temperature increased, COVID-19, Condition aggravated, Cough, Death of relative
Clinical narrative: This is a 22y.o. female with a past medical history of depression who intially presented for chief complaint of suicidal ideation with plan.  Patient reported that she lost her father this past fall and had worsening depression since this time.  She has had intermittent suicidal ideation with worsening suicidal thoughts for the preceding 2 to 3 days.  Patient's mother removed sharp objects in the home as she was contemplating cutting her wrists open. Patient denies any significant past medical history or surgical history. Patient has prior history of admissions for similar complaints.  In the ED, vitals stable.  Labs largely unremarkable. Patient was initially admitted to inpatient psych, however on 8/2 patient noted to have temperature of 103F with tachycardia in the 130's. She also noted HA, cough, and sore throat. Patient was found to be COVID positive and was transferred to medical floor. She is vaccinated against COVID.  Patient was treated supportively and did not require supplemental oxygen, antiviral therapy, or steroids.  Patient reported improvement in her mood and denied suicidal ideations.  Psychiatry was following.  Patient is cleared for discharge at this time with recommendations to follow-up with psychiatry as an outpatient.  Social work provided psychiatric follow-up resources to patient. COVID dc info provided.
Age: 21.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Depression, Headache, Oropharyngeal pain, SARS-CoV-2 test positive, Suicidal ideation
Clinical narrative: This is a 22y.o. female with a past medical history of depression who intially presented for chief complaint of suicidal ideation with plan.  Patient reported that she lost her father this past fall and had worsening depression since this time.  She has had intermittent suicidal ideation with worsening suicidal thoughts for the preceding 2 to 3 days.  Patient's mother removed sharp objects in the home as she was contemplating cutting her wrists open. Patient denies any significant past medical history or surgical history. Patient has prior history of admissions for similar complaints.  In the ED, vitals stable.  Labs largely unremarkable. Patient was initially admitted to inpatient psych, however on 8/2 patient noted to have temperature of 103F with tachycardia in the 130's. She also noted HA, cough, and sore throat. Patient was found to be COVID positive and was transferred to medical floor. She is vaccinated against COVID.  Patient was treated supportively and did not require supplemental oxygen, antiviral therapy, or steroids.  Patient reported improvement in her mood and denied suicidal ideations.  Psychiatry was following.  Patient is cleared for discharge at this time with recommendations to follow-up with psychiatry as an outpatient.  Social work provided psychiatric follow-up resources to patient. COVID dc info provided.
Age: 21.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Tachycardia
Clinical narrative: This is a 22y.o. female with a past medical history of depression who intially presented for chief complaint of suicidal ideation with plan.  Patient reported that she lost her father this past fall and had worsening depression since this time.  She has had intermittent suicidal ideation with worsening suicidal thoughts for the preceding 2 to 3 days.  Patient's mother removed sharp objects in the home as she was contemplating cutting her wrists open. Patient denies any significant past medical history or surgical history. Patient has prior history of admissions for similar complaints.  In the ED, vitals stable.  Labs largely unremarkable. Patient was initially admitted to inpatient psych, however on 8/2 patient noted to have temperature of 103F with tachycardia in the 130's. She also noted HA, cough, and sore throat. Patient was found to be COVID positive and was transferred to medical floor. She is vaccinated against COVID.  Patient was treated supportively and did not require supplemental oxygen, antiviral therapy, or steroids.  Patient reported improvement in her mood and denied suicidal ideations.  Psychiatry was following.  Patient is cleared for discharge at this time with recommendations to follow-up with psychiatry as an outpatient.  Social work provided psychiatric follow-up resources to patient. COVID dc info provided.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Anticoagulant therapy, Atrial fibrillation, Blood thyroid stimulating hormone decreased, COVID-19, Cardioversion
Clinical narrative: 65-year-old woman with history of provoked right lower extremity DVT status post right total knee arthroplasty, HTN, anemia, hypocalcemia who comes to the emergency department due to dizziness, nausea and vomiting.  Started 5 hours before presentation to the ER, she was at store, having episodes of diaphoresis, feeling hot, clammy and top of GI symptoms.  Upon presentation to the ER, she was found to have new onset atrial fibrillation with RVR, heart rate as high as 134, blood pressure as low as 84/53 on the night of presentation.  Received fluid bolus.  She was found to be COVID-positive, vaccinated and posted with 1 booster.  Chest x-ray without acute abnormalities, EKG was reviewed A. fib with RVR, without acute ischemic changes.  Initially started on amiodarone drip which was later discontinued.  TSH was 0.3 with normal free T4.    Patient converted to normal sinus rhythm, started initially on heparin which was transitioned to Eliquis, hydrochlorothiazide and losartan were discontinued, started on Toprol 12.5 mg twice daily with good heart rate control.  Unable to obtain echocardiogram inpatient due to COVID-positive status, okay per cardiology to do an echocardiogram as an outpatient.  Instructed to follow-up with PCP to repeat thyroid function test in 4-6 weeks to rule out hyperthyroidism as an inciting etiology for her atrial fibrillation.  Endocrinology follow-up added in AVS.  Evaluated by ID did not require treatment for COVID during this admission.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Chest X-ray normal, Cold sweat, Dizziness, Electrocardiogram abnormal, Feeling hot
Clinical narrative: 65-year-old woman with history of provoked right lower extremity DVT status post right total knee arthroplasty, HTN, anemia, hypocalcemia who comes to the emergency department due to dizziness, nausea and vomiting.  Started 5 hours before presentation to the ER, she was at store, having episodes of diaphoresis, feeling hot, clammy and top of GI symptoms.  Upon presentation to the ER, she was found to have new onset atrial fibrillation with RVR, heart rate as high as 134, blood pressure as low as 84/53 on the night of presentation.  Received fluid bolus.  She was found to be COVID-positive, vaccinated and posted with 1 booster.  Chest x-ray without acute abnormalities, EKG was reviewed A. fib with RVR, without acute ischemic changes.  Initially started on amiodarone drip which was later discontinued.  TSH was 0.3 with normal free T4.    Patient converted to normal sinus rhythm, started initially on heparin which was transitioned to Eliquis, hydrochlorothiazide and losartan were discontinued, started on Toprol 12.5 mg twice daily with good heart rate control.  Unable to obtain echocardiogram inpatient due to COVID-positive status, okay per cardiology to do an echocardiogram as an outpatient.  Instructed to follow-up with PCP to repeat thyroid function test in 4-6 weeks to rule out hyperthyroidism as an inciting etiology for her atrial fibrillation.  Endocrinology follow-up added in AVS.  Evaluated by ID did not require treatment for COVID during this admission.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Gastrointestinal disorder, Heart rate increased, Hyperhidrosis, Hypotension, Nausea
Clinical narrative: 65-year-old woman with history of provoked right lower extremity DVT status post right total knee arthroplasty, HTN, anemia, hypocalcemia who comes to the emergency department due to dizziness, nausea and vomiting.  Started 5 hours before presentation to the ER, she was at store, having episodes of diaphoresis, feeling hot, clammy and top of GI symptoms.  Upon presentation to the ER, she was found to have new onset atrial fibrillation with RVR, heart rate as high as 134, blood pressure as low as 84/53 on the night of presentation.  Received fluid bolus.  She was found to be COVID-positive, vaccinated and posted with 1 booster.  Chest x-ray without acute abnormalities, EKG was reviewed A. fib with RVR, without acute ischemic changes.  Initially started on amiodarone drip which was later discontinued.  TSH was 0.3 with normal free T4.    Patient converted to normal sinus rhythm, started initially on heparin which was transitioned to Eliquis, hydrochlorothiazide and losartan were discontinued, started on Toprol 12.5 mg twice daily with good heart rate control.  Unable to obtain echocardiogram inpatient due to COVID-positive status, okay per cardiology to do an echocardiogram as an outpatient.  Instructed to follow-up with PCP to repeat thyroid function test in 4-6 weeks to rule out hyperthyroidism as an inciting etiology for her atrial fibrillation.  Endocrinology follow-up added in AVS.  Evaluated by ID did not require treatment for COVID during this admission.
Age: 64.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: SARS-CoV-2 test positive, Thyroxine free normal, Vomiting
Clinical narrative: 65-year-old woman with history of provoked right lower extremity DVT status post right total knee arthroplasty, HTN, anemia, hypocalcemia who comes to the emergency department due to dizziness, nausea and vomiting.  Started 5 hours before presentation to the ER, she was at store, having episodes of diaphoresis, feeling hot, clammy and top of GI symptoms.  Upon presentation to the ER, she was found to have new onset atrial fibrillation with RVR, heart rate as high as 134, blood pressure as low as 84/53 on the night of presentation.  Received fluid bolus.  She was found to be COVID-positive, vaccinated and posted with 1 booster.  Chest x-ray without acute abnormalities, EKG was reviewed A. fib with RVR, without acute ischemic changes.  Initially started on amiodarone drip which was later discontinued.  TSH was 0.3 with normal free T4.    Patient converted to normal sinus rhythm, started initially on heparin which was transitioned to Eliquis, hydrochlorothiazide and losartan were discontinued, started on Toprol 12.5 mg twice daily with good heart rate control.  Unable to obtain echocardiogram inpatient due to COVID-positive status, okay per cardiology to do an echocardiogram as an outpatient.  Instructed to follow-up with PCP to repeat thyroid function test in 4-6 weeks to rule out hyperthyroidism as an inciting etiology for her atrial fibrillation.  Endocrinology follow-up added in AVS.  Evaluated by ID did not require treatment for COVID during this admission.
Age: 77.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Blood culture negative, COVID-19, Chemotherapy, Chest pain, Echocardiogram abnormal
Clinical narrative: 78 year old male with history significant for AAA (stable), HTN, HLD, DM type II, recent Covid-19 (7/21/22) presents to the hospital with chest pain. Cardiology consulted for further evaluation. Echocardiogram completed, revealing LVEF 70%. The left ventricular appears hyperdynamic. No segmental wall motion abnormalities are identified. There is moderately increased thickness of the interventricular septum without significant obstruction to outflow. There is trace valvular regurgitation. There is no pericardial effusion. Pt discharged to home.  well.  She received half dose of Neulasta after chemotherapy. Physical examination was only remarkable for in injected pharynx. Labs on presentation showed WBC of 0.2, RBC 2.69, Hct 25.2, RDW 16, Platelets 45, neutrophil 0.1, Hb 8.8 and CMP was within normal limits. Afterwards, blood culture were sent from oncology, normal saline fluid bolus initiated in clinic,  and patient received first dose of cefepime at 14: 30 in clinic. And patient was started on Paxlovid (nirmatrelevir & ritonavir)1 dose orally twice per day. Patient was diagnosed with febrile neutropenia and was admitted to the inpatient ward to continue IV antibiotics, fluids and for monitoring. On 08/04 at midnight, patient developed a fever of 100.7 and was started on Tylenol. Aftwerwards, her congestion and sore throat improved and patient has been afebrile since. On 08/05, patient was doing well with no fevers, chills or night sweats. However, patient's platelet count decreased to 27 and was given 1 dose of platelet transfusion and no transfusions reactions occured. Furthermore, blood cultures showed no growth at 1 day. Patient was deemed stable for discharge on 08/05 to home.
Age: 77.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Ejection fraction, Febrile neutropenia, Haematocrit decreased, Haemoglobin decreased, Heart valve incompetence
Clinical narrative: 78 year old male with history significant for AAA (stable), HTN, HLD, DM type II, recent Covid-19 (7/21/22) presents to the hospital with chest pain. Cardiology consulted for further evaluation. Echocardiogram completed, revealing LVEF 70%. The left ventricular appears hyperdynamic. No segmental wall motion abnormalities are identified. There is moderately increased thickness of the interventricular septum without significant obstruction to outflow. There is trace valvular regurgitation. There is no pericardial effusion. Pt discharged to home.  well.  She received half dose of Neulasta after chemotherapy. Physical examination was only remarkable for in injected pharynx. Labs on presentation showed WBC of 0.2, RBC 2.69, Hct 25.2, RDW 16, Platelets 45, neutrophil 0.1, Hb 8.8 and CMP was within normal limits. Afterwards, blood culture were sent from oncology, normal saline fluid bolus initiated in clinic,  and patient received first dose of cefepime at 14: 30 in clinic. And patient was started on Paxlovid (nirmatrelevir & ritonavir)1 dose orally twice per day. Patient was diagnosed with febrile neutropenia and was admitted to the inpatient ward to continue IV antibiotics, fluids and for monitoring. On 08/04 at midnight, patient developed a fever of 100.7 and was started on Tylenol. Aftwerwards, her congestion and sore throat improved and patient has been afebrile since. On 08/05, patient was doing well with no fevers, chills or night sweats. However, patient's platelet count decreased to 27 and was given 1 dose of platelet transfusion and no transfusions reactions occured. Furthermore, blood cultures showed no growth at 1 day. Patient was deemed stable for discharge on 08/05 to home.
Age: 77.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Hyperdynamic left ventricle, Metabolic function test, Neutrophil count decreased, Oropharyngeal pain, Platelet count decreased
Clinical narrative: 78 year old male with history significant for AAA (stable), HTN, HLD, DM type II, recent Covid-19 (7/21/22) presents to the hospital with chest pain. Cardiology consulted for further evaluation. Echocardiogram completed, revealing LVEF 70%. The left ventricular appears hyperdynamic. No segmental wall motion abnormalities are identified. There is moderately increased thickness of the interventricular septum without significant obstruction to outflow. There is trace valvular regurgitation. There is no pericardial effusion. Pt discharged to home.  well.  She received half dose of Neulasta after chemotherapy. Physical examination was only remarkable for in injected pharynx. Labs on presentation showed WBC of 0.2, RBC 2.69, Hct 25.2, RDW 16, Platelets 45, neutrophil 0.1, Hb 8.8 and CMP was within normal limits. Afterwards, blood culture were sent from oncology, normal saline fluid bolus initiated in clinic,  and patient received first dose of cefepime at 14: 30 in clinic. And patient was started on Paxlovid (nirmatrelevir & ritonavir)1 dose orally twice per day. Patient was diagnosed with febrile neutropenia and was admitted to the inpatient ward to continue IV antibiotics, fluids and for monitoring. On 08/04 at midnight, patient developed a fever of 100.7 and was started on Tylenol. Aftwerwards, her congestion and sore throat improved and patient has been afebrile since. On 08/05, patient was doing well with no fevers, chills or night sweats. However, patient's platelet count decreased to 27 and was given 1 dose of platelet transfusion and no transfusions reactions occured. Furthermore, blood cultures showed no growth at 1 day. Patient was deemed stable for discharge on 08/05 to home.
Age: 77.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Platelet transfusion, Pyrexia, Red blood cell count decreased, Red cell distribution width increased, Respiratory tract congestion
Clinical narrative: 78 year old male with history significant for AAA (stable), HTN, HLD, DM type II, recent Covid-19 (7/21/22) presents to the hospital with chest pain. Cardiology consulted for further evaluation. Echocardiogram completed, revealing LVEF 70%. The left ventricular appears hyperdynamic. No segmental wall motion abnormalities are identified. There is moderately increased thickness of the interventricular septum without significant obstruction to outflow. There is trace valvular regurgitation. There is no pericardial effusion. Pt discharged to home.  well.  She received half dose of Neulasta after chemotherapy. Physical examination was only remarkable for in injected pharynx. Labs on presentation showed WBC of 0.2, RBC 2.69, Hct 25.2, RDW 16, Platelets 45, neutrophil 0.1, Hb 8.8 and CMP was within normal limits. Afterwards, blood culture were sent from oncology, normal saline fluid bolus initiated in clinic,  and patient received first dose of cefepime at 14: 30 in clinic. And patient was started on Paxlovid (nirmatrelevir & ritonavir)1 dose orally twice per day. Patient was diagnosed with febrile neutropenia and was admitted to the inpatient ward to continue IV antibiotics, fluids and for monitoring. On 08/04 at midnight, patient developed a fever of 100.7 and was started on Tylenol. Aftwerwards, her congestion and sore throat improved and patient has been afebrile since. On 08/05, patient was doing well with no fevers, chills or night sweats. However, patient's platelet count decreased to 27 and was given 1 dose of platelet transfusion and no transfusions reactions occured. Furthermore, blood cultures showed no growth at 1 day. Patient was deemed stable for discharge on 08/05 to home.
Age: 77.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: SARS-CoV-2 test positive, Ventricular hypertrophy, White blood cell count decreased
Clinical narrative: 78 year old male with history significant for AAA (stable), HTN, HLD, DM type II, recent Covid-19 (7/21/22) presents to the hospital with chest pain. Cardiology consulted for further evaluation. Echocardiogram completed, revealing LVEF 70%. The left ventricular appears hyperdynamic. No segmental wall motion abnormalities are identified. There is moderately increased thickness of the interventricular septum without significant obstruction to outflow. There is trace valvular regurgitation. There is no pericardial effusion. Pt discharged to home.  well.  She received half dose of Neulasta after chemotherapy. Physical examination was only remarkable for in injected pharynx. Labs on presentation showed WBC of 0.2, RBC 2.69, Hct 25.2, RDW 16, Platelets 45, neutrophil 0.1, Hb 8.8 and CMP was within normal limits. Afterwards, blood culture were sent from oncology, normal saline fluid bolus initiated in clinic,  and patient received first dose of cefepime at 14: 30 in clinic. And patient was started on Paxlovid (nirmatrelevir & ritonavir)1 dose orally twice per day. Patient was diagnosed with febrile neutropenia and was admitted to the inpatient ward to continue IV antibiotics, fluids and for monitoring. On 08/04 at midnight, patient developed a fever of 100.7 and was started on Tylenol. Aftwerwards, her congestion and sore throat improved and patient has been afebrile since. On 08/05, patient was doing well with no fevers, chills or night sweats. However, patient's platelet count decreased to 27 and was given 1 dose of platelet transfusion and no transfusions reactions occured. Furthermore, blood cultures showed no growth at 1 day. Patient was deemed stable for discharge on 08/05 to home.
Age: 78.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Abdominal pain, Abscess drainage, Appendicectomy, Appendicitis, Appendicitis perforated
Clinical narrative: Pt presented to the ER with abdominal pain; workup demonstrated appendicitis. Pt had covid last month, which was complicated by pna and was on azithromycin. Pt had worsening leukocytosis and pain and was taken to OR for lap appendectomy 8/4 with perforated appendicitis and drainage of abscess. Post-op pt had a T of 100.2 which resolved with tylenol. She also was not able to have a BM post-op. She also wanted to be seen by ID to evaluate her due to her concerns for pna and her appendectomy. ID saw pt and recommended for her to have ciprofloxacin 500mg BID and metronidazole 500 mg TID till 8/18. Pt did not have any more fevers and was able to have BM. well.  She received half dose of Neulasta after chemotherapy. Physical examination was only remarkable for in injected pharynx. Labs on presentation showed WBC of 0.2, RBC 2.69, Hct 25.2, RDW 16, Platelets 45, neutrophil 0.1, Hb 8.8 and CMP was within normal limits. Afterwards, blood culture were sent from doctor, normal saline fluid bolus initiated in clinic,  and patient received first dose of cefepime at 14: 30 in clinic. And patient was started on Paxlovid (nirmatrelevir & ritonavir)1 dose orally twice per day. Patient was diagnosed with febrile neutropenia and was admitted to the inpatient ward to continue IV antibiotics, fluids and for monitoring. On 08/04 at midnight, patient developed a fever of 100.7 and was started on Tylenol. Aftwerwards, her congestion and sore throat improved and patient has been afebrile since. On 08/05, patient was doing well with no fevers, chills or night sweats. However, patient's platelet count decreased to 27 and was given 1 dose of platelet transfusion and no transfusions reactions occured. Furthermore, blood cultures showed no growth at 1 day. Patient was deemed stable for discharge on 08/05 to home.
Age: 78.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Blood culture negative, COVID-19, Chemotherapy, Constipation, Febrile neutropenia
Clinical narrative: Pt presented to the ER with abdominal pain; workup demonstrated appendicitis. Pt had covid last month, which was complicated by pna and was on azithromycin. Pt had worsening leukocytosis and pain and was taken to OR for lap appendectomy 8/4 with perforated appendicitis and drainage of abscess. Post-op pt had a T of 100.2 which resolved with tylenol. She also was not able to have a BM post-op. She also wanted to be seen by ID to evaluate her due to her concerns for pna and her appendectomy. ID saw pt and recommended for her to have ciprofloxacin 500mg BID and metronidazole 500 mg TID till 8/18. Pt did not have any more fevers and was able to have BM. well.  She received half dose of Neulasta after chemotherapy. Physical examination was only remarkable for in injected pharynx. Labs on presentation showed WBC of 0.2, RBC 2.69, Hct 25.2, RDW 16, Platelets 45, neutrophil 0.1, Hb 8.8 and CMP was within normal limits. Afterwards, blood culture were sent from doctor, normal saline fluid bolus initiated in clinic,  and patient received first dose of cefepime at 14: 30 in clinic. And patient was started on Paxlovid (nirmatrelevir & ritonavir)1 dose orally twice per day. Patient was diagnosed with febrile neutropenia and was admitted to the inpatient ward to continue IV antibiotics, fluids and for monitoring. On 08/04 at midnight, patient developed a fever of 100.7 and was started on Tylenol. Aftwerwards, her congestion and sore throat improved and patient has been afebrile since. On 08/05, patient was doing well with no fevers, chills or night sweats. However, patient's platelet count decreased to 27 and was given 1 dose of platelet transfusion and no transfusions reactions occured. Furthermore, blood cultures showed no growth at 1 day. Patient was deemed stable for discharge on 08/05 to home.
Age: 78.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Haematocrit decreased, Haemoglobin decreased, Laparoscopic surgery, Leukocytosis, Metabolic function test normal
Clinical narrative: Pt presented to the ER with abdominal pain; workup demonstrated appendicitis. Pt had covid last month, which was complicated by pna and was on azithromycin. Pt had worsening leukocytosis and pain and was taken to OR for lap appendectomy 8/4 with perforated appendicitis and drainage of abscess. Post-op pt had a T of 100.2 which resolved with tylenol. She also was not able to have a BM post-op. She also wanted to be seen by ID to evaluate her due to her concerns for pna and her appendectomy. ID saw pt and recommended for her to have ciprofloxacin 500mg BID and metronidazole 500 mg TID till 8/18. Pt did not have any more fevers and was able to have BM. well.  She received half dose of Neulasta after chemotherapy. Physical examination was only remarkable for in injected pharynx. Labs on presentation showed WBC of 0.2, RBC 2.69, Hct 25.2, RDW 16, Platelets 45, neutrophil 0.1, Hb 8.8 and CMP was within normal limits. Afterwards, blood culture were sent from doctor, normal saline fluid bolus initiated in clinic,  and patient received first dose of cefepime at 14: 30 in clinic. And patient was started on Paxlovid (nirmatrelevir & ritonavir)1 dose orally twice per day. Patient was diagnosed with febrile neutropenia and was admitted to the inpatient ward to continue IV antibiotics, fluids and for monitoring. On 08/04 at midnight, patient developed a fever of 100.7 and was started on Tylenol. Aftwerwards, her congestion and sore throat improved and patient has been afebrile since. On 08/05, patient was doing well with no fevers, chills or night sweats. However, patient's platelet count decreased to 27 and was given 1 dose of platelet transfusion and no transfusions reactions occured. Furthermore, blood cultures showed no growth at 1 day. Patient was deemed stable for discharge on 08/05 to home.
Age: 78.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Neutrophil count decreased, Oropharyngeal pain, Pain, Platelet count decreased, Platelet transfusion
Clinical narrative: Pt presented to the ER with abdominal pain; workup demonstrated appendicitis. Pt had covid last month, which was complicated by pna and was on azithromycin. Pt had worsening leukocytosis and pain and was taken to OR for lap appendectomy 8/4 with perforated appendicitis and drainage of abscess. Post-op pt had a T of 100.2 which resolved with tylenol. She also was not able to have a BM post-op. She also wanted to be seen by ID to evaluate her due to her concerns for pna and her appendectomy. ID saw pt and recommended for her to have ciprofloxacin 500mg BID and metronidazole 500 mg TID till 8/18. Pt did not have any more fevers and was able to have BM. well.  She received half dose of Neulasta after chemotherapy. Physical examination was only remarkable for in injected pharynx. Labs on presentation showed WBC of 0.2, RBC 2.69, Hct 25.2, RDW 16, Platelets 45, neutrophil 0.1, Hb 8.8 and CMP was within normal limits. Afterwards, blood culture were sent from doctor, normal saline fluid bolus initiated in clinic,  and patient received first dose of cefepime at 14: 30 in clinic. And patient was started on Paxlovid (nirmatrelevir & ritonavir)1 dose orally twice per day. Patient was diagnosed with febrile neutropenia and was admitted to the inpatient ward to continue IV antibiotics, fluids and for monitoring. On 08/04 at midnight, patient developed a fever of 100.7 and was started on Tylenol. Aftwerwards, her congestion and sore throat improved and patient has been afebrile since. On 08/05, patient was doing well with no fevers, chills or night sweats. However, patient's platelet count decreased to 27 and was given 1 dose of platelet transfusion and no transfusions reactions occured. Furthermore, blood cultures showed no growth at 1 day. Patient was deemed stable for discharge on 08/05 to home.
Age: 78.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Pneumonia, Pyrexia, Red blood cell count decreased, Red cell distribution width increased, Respiratory tract congestion
Clinical narrative: Pt presented to the ER with abdominal pain; workup demonstrated appendicitis. Pt had covid last month, which was complicated by pna and was on azithromycin. Pt had worsening leukocytosis and pain and was taken to OR for lap appendectomy 8/4 with perforated appendicitis and drainage of abscess. Post-op pt had a T of 100.2 which resolved with tylenol. She also was not able to have a BM post-op. She also wanted to be seen by ID to evaluate her due to her concerns for pna and her appendectomy. ID saw pt and recommended for her to have ciprofloxacin 500mg BID and metronidazole 500 mg TID till 8/18. Pt did not have any more fevers and was able to have BM. well.  She received half dose of Neulasta after chemotherapy. Physical examination was only remarkable for in injected pharynx. Labs on presentation showed WBC of 0.2, RBC 2.69, Hct 25.2, RDW 16, Platelets 45, neutrophil 0.1, Hb 8.8 and CMP was within normal limits. Afterwards, blood culture were sent from doctor, normal saline fluid bolus initiated in clinic,  and patient received first dose of cefepime at 14: 30 in clinic. And patient was started on Paxlovid (nirmatrelevir & ritonavir)1 dose orally twice per day. Patient was diagnosed with febrile neutropenia and was admitted to the inpatient ward to continue IV antibiotics, fluids and for monitoring. On 08/04 at midnight, patient developed a fever of 100.7 and was started on Tylenol. Aftwerwards, her congestion and sore throat improved and patient has been afebrile since. On 08/05, patient was doing well with no fevers, chills or night sweats. However, patient's platelet count decreased to 27 and was given 1 dose of platelet transfusion and no transfusions reactions occured. Furthermore, blood cultures showed no growth at 1 day. Patient was deemed stable for discharge on 08/05 to home.
Age: 78.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: SARS-CoV-2 test positive, White blood cell count decreased
Clinical narrative: Pt presented to the ER with abdominal pain; workup demonstrated appendicitis. Pt had covid last month, which was complicated by pna and was on azithromycin. Pt had worsening leukocytosis and pain and was taken to OR for lap appendectomy 8/4 with perforated appendicitis and drainage of abscess. Post-op pt had a T of 100.2 which resolved with tylenol. She also was not able to have a BM post-op. She also wanted to be seen by ID to evaluate her due to her concerns for pna and her appendectomy. ID saw pt and recommended for her to have ciprofloxacin 500mg BID and metronidazole 500 mg TID till 8/18. Pt did not have any more fevers and was able to have BM. well.  She received half dose of Neulasta after chemotherapy. Physical examination was only remarkable for in injected pharynx. Labs on presentation showed WBC of 0.2, RBC 2.69, Hct 25.2, RDW 16, Platelets 45, neutrophil 0.1, Hb 8.8 and CMP was within normal limits. Afterwards, blood culture were sent from doctor, normal saline fluid bolus initiated in clinic,  and patient received first dose of cefepime at 14: 30 in clinic. And patient was started on Paxlovid (nirmatrelevir & ritonavir)1 dose orally twice per day. Patient was diagnosed with febrile neutropenia and was admitted to the inpatient ward to continue IV antibiotics, fluids and for monitoring. On 08/04 at midnight, patient developed a fever of 100.7 and was started on Tylenol. Aftwerwards, her congestion and sore throat improved and patient has been afebrile since. On 08/05, patient was doing well with no fevers, chills or night sweats. However, patient's platelet count decreased to 27 and was given 1 dose of platelet transfusion and no transfusions reactions occured. Furthermore, blood cultures showed no growth at 1 day. Patient was deemed stable for discharge on 08/05 to home.
Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Anticoagulant therapy, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Dyspnoea
Clinical narrative: 57-year-old female with known history of end-stage renal disease, presently on dialysis. Patient recently discharged from the hospital, returned with shortness of breath and fever. Patient evaluated in the emergency room, and found to be COVID-19 positive. Chest x-ray was consistent with COVID-19 associated pneumonia. The patient required oxygen, was admitted to the hospital. She was started on Decadron, anticoagulation therapy and administered 5 days of remdesivir. The patient became nontoxic, afebrile and reverted to her usual oxygen requirement. Dialysis provided throughout. Subsequently, the patient wished to return for physical and occupational therapy. Discharge planner was consulted after many days of attempting to obtain placement for the patient. The patient stated she wished to be discharged home. She was subsequently discharged from the hospital. All medications and instructions were provided.  She was also provided with an additional prescription for percutaneous biopsy of renal mass with the plan being if this shows cancer, she will undergo cryoablation of the mass.
Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Pyrexia, Renal mass, SARS-CoV-2 test positive
Clinical narrative: 57-year-old female with known history of end-stage renal disease, presently on dialysis. Patient recently discharged from the hospital, returned with shortness of breath and fever. Patient evaluated in the emergency room, and found to be COVID-19 positive. Chest x-ray was consistent with COVID-19 associated pneumonia. The patient required oxygen, was admitted to the hospital. She was started on Decadron, anticoagulation therapy and administered 5 days of remdesivir. The patient became nontoxic, afebrile and reverted to her usual oxygen requirement. Dialysis provided throughout. Subsequently, the patient wished to return for physical and occupational therapy. Discharge planner was consulted after many days of attempting to obtain placement for the patient. The patient stated she wished to be discharged home. She was subsequently discharged from the hospital. All medications and instructions were provided.  She was also provided with an additional prescription for percutaneous biopsy of renal mass with the plan being if this shows cancer, she will undergo cryoablation of the mass.
Age: 85.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Blood folate normal, Blood thyroid stimulating hormone normal, Brain natriuretic peptide increased, COVID-19, Delirium
Clinical narrative: 86 yo F with PMH CHF, arthritis who presents on 8/4 for SOB x several weeks but worse over past 4-5 days. In the EC, initial lab work revealed BNP: 1, 892; Elevated Trop (0.07 > 0.06).  EKG w/ nonspecific T wave changes.  Additionally found to be COVID-19 positive. Pt given IV Lasix and admitted. ID evaluated and COVID precautions removed as unlikely active infection. Cardiology consulted.  2D echo w/ global hypokinesis, WMA, EF 30%, severely decreased RV function, severe MR. She was changed to PO lasix 8/9. Per cardiology not a current candidate for ischemic work up provided throughout. Started on Lopressor 8/8 for frequent PVC, transitioned to Toprol XL. Pt w/ 25bt Vrun, amiodarone initiated. Geriatrics consulted due to delirium. Folate, B12, TSH WNL. Initiated melatonin, family encouraged to bring in hearing aids. Likely underlying dementia. Son is interested in transition to hospice soon, informational meeting ordered. Pt stable and discharged to SAR in the interim.
Age: 85.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Dementia, Dyspnoea, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram T wave abnormal
Clinical narrative: 86 yo F with PMH CHF, arthritis who presents on 8/4 for SOB x several weeks but worse over past 4-5 days. In the EC, initial lab work revealed BNP: 1, 892; Elevated Trop (0.07 > 0.06).  EKG w/ nonspecific T wave changes.  Additionally found to be COVID-19 positive. Pt given IV Lasix and admitted. ID evaluated and COVID precautions removed as unlikely active infection. Cardiology consulted.  2D echo w/ global hypokinesis, WMA, EF 30%, severely decreased RV function, severe MR. She was changed to PO lasix 8/9. Per cardiology not a current candidate for ischemic work up provided throughout. Started on Lopressor 8/8 for frequent PVC, transitioned to Toprol XL. Pt w/ 25bt Vrun, amiodarone initiated. Geriatrics consulted due to delirium. Folate, B12, TSH WNL. Initiated melatonin, family encouraged to bring in hearing aids. Likely underlying dementia. Son is interested in transition to hospice soon, informational meeting ordered. Pt stable and discharged to SAR in the interim.
Age: 85.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Mitral valve incompetence, Right ventricular dysfunction, SARS-CoV-2 test positive, Troponin increased, Ventricular extrasystoles
Clinical narrative: 86 yo F with PMH CHF, arthritis who presents on 8/4 for SOB x several weeks but worse over past 4-5 days. In the EC, initial lab work revealed BNP: 1, 892; Elevated Trop (0.07 > 0.06).  EKG w/ nonspecific T wave changes.  Additionally found to be COVID-19 positive. Pt given IV Lasix and admitted. ID evaluated and COVID precautions removed as unlikely active infection. Cardiology consulted.  2D echo w/ global hypokinesis, WMA, EF 30%, severely decreased RV function, severe MR. She was changed to PO lasix 8/9. Per cardiology not a current candidate for ischemic work up provided throughout. Started on Lopressor 8/8 for frequent PVC, transitioned to Toprol XL. Pt w/ 25bt Vrun, amiodarone initiated. Geriatrics consulted due to delirium. Folate, B12, TSH WNL. Initiated melatonin, family encouraged to bring in hearing aids. Likely underlying dementia. Son is interested in transition to hospice soon, informational meeting ordered. Pt stable and discharged to SAR in the interim.
Age: 85.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Ventricular hypokinesia, Vitamin B12 normal, Wall motion score index abnormal
Clinical narrative: 86 yo F with PMH CHF, arthritis who presents on 8/4 for SOB x several weeks but worse over past 4-5 days. In the EC, initial lab work revealed BNP: 1, 892; Elevated Trop (0.07 > 0.06).  EKG w/ nonspecific T wave changes.  Additionally found to be COVID-19 positive. Pt given IV Lasix and admitted. ID evaluated and COVID precautions removed as unlikely active infection. Cardiology consulted.  2D echo w/ global hypokinesis, WMA, EF 30%, severely decreased RV function, severe MR. She was changed to PO lasix 8/9. Per cardiology not a current candidate for ischemic work up provided throughout. Started on Lopressor 8/8 for frequent PVC, transitioned to Toprol XL. Pt w/ 25bt Vrun, amiodarone initiated. Geriatrics consulted due to delirium. Folate, B12, TSH WNL. Initiated melatonin, family encouraged to bring in hearing aids. Likely underlying dementia. Son is interested in transition to hospice soon, informational meeting ordered. Pt stable and discharged to SAR in the interim.
Age: 66.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Acute kidney injury, Anaemia, Asymptomatic COVID-19, Blood loss anaemia, Bone graft
Clinical narrative: 67 yo female with Hx of breast cancer, remote bilateral THA, DVT/PE on xarelto, OCD, DM2, morbid obesity presented following a fall causing femur fracture    Right periprosthetic proximal femur fracture with non union  - s/p revision right total hip arthroplasty, repair proximal femur nonunion with bone graft substitute 8/8 - post operative and pain management and peri operative antibiotics per orthopedics   Acute on chronic anemia - now stable - suspected mostly post operative blood loss. No active bleeding noted. - baseline Hb around 11, decreased to around 8 post operatively, now stable around 7.5   Hx of DVT/PE - per patient, approximately one year ago. Per her report, anticoagulation lifelong. On outpatient rivaroxiban - currently on prophylactic enoxaparin. Resume home rivaroxiban 10mg daily Would continue rivaroxiban indefinately given she was previously on this prior to admission   DM2 - hold home metformin, likely can resume at discharge - HbA1c 6.7% this admission - basal, SSI/IIT. Diabetic diet. Goal blood glucose 140-180. Will not need insulin at discharge, only metformin given above HbA1c    AKI - resolved - noted post operatively   Constipation - postoperative, narcotic associated, immobility  - cont bowel regimen, daily Miralax. May require enema or suppository   COVID 19 infection, asymptomatic - positive test 8/2/22 - evaluated by ID at WBH GP: no further treatment needed   HTN  - resume metoprolol   Right breast skin ulcer: 2/2 self inflicted injury/skin picking due to pt's OCD  - no signs of infection, dry dressing if needed   OCD Mood disorder - cont home buspirone, clonazepam, fluoxetine, risperidone    Hypovitaminosis D - vitamin D supplementation   Hx of breast cancer >20 years ago S/P mastectomy/chemo and radiation  Morbid obesity :  weight loss GERD : resume omeprazole      Stable for discharge to ECF from medical standpoint
Age: 66.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Condition aggravated, Dermatillomania, Fall, Femur fracture, Fracture nonunion
Clinical narrative: 67 yo female with Hx of breast cancer, remote bilateral THA, DVT/PE on xarelto, OCD, DM2, morbid obesity presented following a fall causing femur fracture    Right periprosthetic proximal femur fracture with non union  - s/p revision right total hip arthroplasty, repair proximal femur nonunion with bone graft substitute 8/8 - post operative and pain management and peri operative antibiotics per orthopedics   Acute on chronic anemia - now stable - suspected mostly post operative blood loss. No active bleeding noted. - baseline Hb around 11, decreased to around 8 post operatively, now stable around 7.5   Hx of DVT/PE - per patient, approximately one year ago. Per her report, anticoagulation lifelong. On outpatient rivaroxiban - currently on prophylactic enoxaparin. Resume home rivaroxiban 10mg daily Would continue rivaroxiban indefinately given she was previously on this prior to admission   DM2 - hold home metformin, likely can resume at discharge - HbA1c 6.7% this admission - basal, SSI/IIT. Diabetic diet. Goal blood glucose 140-180. Will not need insulin at discharge, only metformin given above HbA1c    AKI - resolved - noted post operatively   Constipation - postoperative, narcotic associated, immobility  - cont bowel regimen, daily Miralax. May require enema or suppository   COVID 19 infection, asymptomatic - positive test 8/2/22 - evaluated by ID at WBH GP: no further treatment needed   HTN  - resume metoprolol   Right breast skin ulcer: 2/2 self inflicted injury/skin picking due to pt's OCD  - no signs of infection, dry dressing if needed   OCD Mood disorder - cont home buspirone, clonazepam, fluoxetine, risperidone    Hypovitaminosis D - vitamin D supplementation   Hx of breast cancer >20 years ago S/P mastectomy/chemo and radiation  Morbid obesity :  weight loss GERD : resume omeprazole      Stable for discharge to ECF from medical standpoint
Age: 66.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Glycosylated haemoglobin normal, Haemoglobin decreased, Obsessive-compulsive disorder, Periprosthetic fracture, Post procedural constipation
Clinical narrative: 67 yo female with Hx of breast cancer, remote bilateral THA, DVT/PE on xarelto, OCD, DM2, morbid obesity presented following a fall causing femur fracture    Right periprosthetic proximal femur fracture with non union  - s/p revision right total hip arthroplasty, repair proximal femur nonunion with bone graft substitute 8/8 - post operative and pain management and peri operative antibiotics per orthopedics   Acute on chronic anemia - now stable - suspected mostly post operative blood loss. No active bleeding noted. - baseline Hb around 11, decreased to around 8 post operatively, now stable around 7.5   Hx of DVT/PE - per patient, approximately one year ago. Per her report, anticoagulation lifelong. On outpatient rivaroxiban - currently on prophylactic enoxaparin. Resume home rivaroxiban 10mg daily Would continue rivaroxiban indefinately given she was previously on this prior to admission   DM2 - hold home metformin, likely can resume at discharge - HbA1c 6.7% this admission - basal, SSI/IIT. Diabetic diet. Goal blood glucose 140-180. Will not need insulin at discharge, only metformin given above HbA1c    AKI - resolved - noted post operatively   Constipation - postoperative, narcotic associated, immobility  - cont bowel regimen, daily Miralax. May require enema or suppository   COVID 19 infection, asymptomatic - positive test 8/2/22 - evaluated by ID at WBH GP: no further treatment needed   HTN  - resume metoprolol   Right breast skin ulcer: 2/2 self inflicted injury/skin picking due to pt's OCD  - no signs of infection, dry dressing if needed   OCD Mood disorder - cont home buspirone, clonazepam, fluoxetine, risperidone    Hypovitaminosis D - vitamin D supplementation   Hx of breast cancer >20 years ago S/P mastectomy/chemo and radiation  Morbid obesity :  weight loss GERD : resume omeprazole      Stable for discharge to ECF from medical standpoint