chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Slow response to stimuli, Tobacco user, Troponin increased, Wheezing
Clinical narrative: Patient is a 83 y.o. female patient of DO with history of COPD, hypertension, DM type 2, CAD, CKD presented to Hospital with AMS .   AMS Likely multifactorial with COVID, hypoglycemia Slurred speech and slow to respond reported by family, glucose by medics 101 Febrile T max 100.8  CT head negative for acute intracranial abnormality, moderate large amount of chronic microvascular ischemic change in supratentorial white matter UDS - negative  S/b Neurology AMS likely from covid and hypoglycemia  No indication for MRI Brain    Acute Hypoxic Respiratory Failure No home o2 at baseline RA 88% 2L NC on admission Supportive care as below  Now on room air.   Covid-19 Virus Infection Date of onset of symptoms: 11/24/2022 Symptoms present on admission: fever, cough  Date of covid positive test: 11/24/2022 Vaccination status: vaccinated Imaging: CXR cardiomegaly, pulmonary vascular congestion  Oxygen requirements on admission: 2L Current oxygen requirements: 2L Medical therapy: steroids and remdesivir Consultants following: ID Anticipated special isolation end date: 12/4/2022 Completed 5-day course of remdesivir. Switch to oral dexamethasone to 6 mg daily for 4 more days to complete a 10-day course.   COPD Exacerbation In setting of COVID and tobacco abuse  Diffuse wheezing on exam VBG 7.41 co2 45 po2 102 Hco3 28 Requiring 2L nc on admission Completed Zithromax dose.   DM type 2 Episode Hypoglycemia  Glucose in ED 41 treated with dextrose repeat 500 likely inaccurate  Repeat chem 128  Resume home regimen.  Elevated Troponin  CAD HFpEF Echo 1/2020 EF 60%, mild diastolic dysfunction Trop 27 ECG non ischemic  CXR pulm vascular congestion, bilateral lower extremity edema Was on 40 mg IV lasix daily, now on hold due to elevated creatinine Repeat 2D echocardiogram on 1128 showed EF of 50 to 60% and grade 2 diastolic dysfunction. Continue to monitor on tele, delta essentially flat Continue Lipitor   AKI on CKD stage 3 Creatine 1.26 on admission Slightly better then baseline (2.23-1.52) Avoid nephrotoxic medications  Cr 1.6 - monitor Creatinine back to baseline   Tobacco Abuse Continues to smoke NRT  Debility. PT and OT recommended home with home health. She will be discharged home today.
Age: 77.0
Sex: M
Vaccine: COVID19-2
Symptoms: Product preparation issue, Product storage error
Clinical narrative: The patient was given a dose of the undiluted (Gray cap) Pfizer COVID-19 Bivalent booster that was not stored in an ultra-cold temperature freezer and was instead stored in the regular freezer (between -30 to -20 F). It was moved out of the regular freezer to the refrigerator after more than 3 weeks in the regular freezer. The doses were then used after more than 24 hours in the refrigerator. We have contacted Pfizer about this and according to their off-label studies they provided via PDF file, they are not able to support the temperature excursions that occurred. As per guidance, the recommendation is to re-vaccinate the individual with the full authorized dose of any Bivalent vaccine (either Pfizer or Moderna) and we have communicated with the patient for re-vaccination.
Age: 71.0
Sex: M
Vaccine: COVID19-2
Symptoms: COVID-19, Fatigue, Nasal congestion, Nasopharyngitis, Respiratory tract congestion
Clinical narrative: On 12/15/ 2022 I started feeling as if I had a cold. I had nasal and head congestion; constant runny nose;fatigue. Tested positive on 12/19/2022 I had a telehealth visit and was prescribed a course of Paxlovid.
Age: 71.0
Sex: M
Vaccine: COVID19-2
Symptoms: Rhinorrhoea, SARS-CoV-2 test positive
Clinical narrative: On 12/15/ 2022 I started feeling as if I had a cold. I had nasal and head congestion; constant runny nose;fatigue. Tested positive on 12/19/2022 I had a telehealth visit and was prescribed a course of Paxlovid.
Age: 84.0
Sex: M
Vaccine: COVID19-2
Symptoms: Product storage error
Clinical narrative: Error: Improper Storage (ex. temp./location)-
Age: 54.0
Sex: M
Vaccine: COVID19-2
Symptoms: Product preparation issue, Product storage error
Clinical narrative: The patient was given a dose of the undiluted (Gray cap) Pfizer COVID-19 Bivalent booster that was not stored in an ultra-cold temperature freezer and was instead stored in the regular freezer (between -30 to -20 F). It was moved out of the regular freezer to the refrigerator after more than 3 weeks in the regular freezer. The doses were then used after more than 24 hours in the refrigerator. We have contacted Pfizer about this and according to their off-label studies they provided via PDF file, they are not able to support the temperature excursions that occurred. As per guidance, the recommendation is to re-vaccinate the individual with the full authorized dose of any Bivalent vaccine (either Pfizer or Moderna) and we have communicated with the patient for re-vaccination.
Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Anaemia, Anticoagulant therapy, Aspiration, Atrial fibrillation
Clinical narrative: Hospital Course:    Patient is a 90 y.o. male patient of DO with a history of mild dementia but living independently presented to Hospital 12/05/2022 with chest discomfort radiating to both arms.  His symptoms had begun the day before but were less specific.  He was found to have ST elevation, albeit with Q waves across the anterior precordium.  Due to ongoing symptomatology he was taken to the cardiac catheterization lab where he underwent intervention to the LAD successfully.   He continues to have issues with sundowning, but now is in sinus rhythm and his renal function has normalized.  He was then discharged home 12/10/2022 with home health assistance.  He will also follow-up with cardiology.    Discharge Diagnoses:   Anterior STEMI Risk factors: HLD, CKD, Heart Score: 8. Presented with chest pain of unclear duration -Troponin 2,501, EKG with ST elevations V4/5/6, LHC mid/distal LAD showing complete occlusion Timi flow 0 -- > timi 3 flow after intervention.  -Continue eliquis, plavix, atorvistatin, lisinopril 5 mg    Paroxsymal A Fib. With RVR Likely in the setting of recent MI and volume depleted status -Received Lopressor IV 2.5 x 4 overnight with improvement of HR -transition from amio gtt to oral amio 200 mg BID, after risks and benefits discussion with family, will transition to 2.5mg of eliquis twice daily  -We will arrange follow-up with cardiology as outpatient locally,    Aspiration Pneumonitis In the setting of emesis, with potential chronic contributions -leukocytosis, with CXR changes per above -Transition to augmentin for 5 days therapy total, SLP consulted for swallow minor aspiration with strong cough reflex recommend pureed diet.    Urinary Retention Unclear etiology, possibly underlying chronic retention exacerbated by poor intake -Foley removed 12/09 -Plan: Will encourage patient to spontaneously void on his own, may require further workup if not -patient will f/u with known urologist, Dr.     CKD IV Baseline Cr 1.8-2.0, not on iHD -Cr at baseline -Continue to monitor   Acute Hypoxemic Respiratory Failure, improving In the setting of an aspiration event. -CXR showing retrocardiac opacities consistent with aspiration -continue supplemental O2 wean with goal sat >88%. Patient may need homegoing O2 Anemia Likely associated with CKD, cannot rule out mineral or vitamin def playing a role. -Hgb 11.2, Iron panel showing iron def, b12/folate wnl -Continue ferrous sulfate 325 mg EOD, Continue to monitor transfuse hgb<7      Abnormal CXR Etiology unclear, primary concern would be potential underlying malginancy -Non-emergent CT chest recommended, however patient transitioned to DNR-CC   GOC Due to continuing decline.  -Palliative care consulted for GOC and EOL discussion. Transitioned to DNR-CC. Patient does not qualify for hospice at this time -Patient will require a hospital bed after evaluation in the hospital
Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Bladder catheter removal, Bladder catheterisation, Blood creatinine increased, Blood folate normal, Blood iron decreased
Clinical narrative: Hospital Course:    Patient is a 90 y.o. male patient of DO with a history of mild dementia but living independently presented to Hospital 12/05/2022 with chest discomfort radiating to both arms.  His symptoms had begun the day before but were less specific.  He was found to have ST elevation, albeit with Q waves across the anterior precordium.  Due to ongoing symptomatology he was taken to the cardiac catheterization lab where he underwent intervention to the LAD successfully.   He continues to have issues with sundowning, but now is in sinus rhythm and his renal function has normalized.  He was then discharged home 12/10/2022 with home health assistance.  He will also follow-up with cardiology.    Discharge Diagnoses:   Anterior STEMI Risk factors: HLD, CKD, Heart Score: 8. Presented with chest pain of unclear duration -Troponin 2,501, EKG with ST elevations V4/5/6, LHC mid/distal LAD showing complete occlusion Timi flow 0 -- > timi 3 flow after intervention.  -Continue eliquis, plavix, atorvistatin, lisinopril 5 mg    Paroxsymal A Fib. With RVR Likely in the setting of recent MI and volume depleted status -Received Lopressor IV 2.5 x 4 overnight with improvement of HR -transition from amio gtt to oral amio 200 mg BID, after risks and benefits discussion with family, will transition to 2.5mg of eliquis twice daily  -We will arrange follow-up with cardiology as outpatient locally,    Aspiration Pneumonitis In the setting of emesis, with potential chronic contributions -leukocytosis, with CXR changes per above -Transition to augmentin for 5 days therapy total, SLP consulted for swallow minor aspiration with strong cough reflex recommend pureed diet.    Urinary Retention Unclear etiology, possibly underlying chronic retention exacerbated by poor intake -Foley removed 12/09 -Plan: Will encourage patient to spontaneously void on his own, may require further workup if not -patient will f/u with known urologist, Dr.     CKD IV Baseline Cr 1.8-2.0, not on iHD -Cr at baseline -Continue to monitor   Acute Hypoxemic Respiratory Failure, improving In the setting of an aspiration event. -CXR showing retrocardiac opacities consistent with aspiration -continue supplemental O2 wean with goal sat >88%. Patient may need homegoing O2 Anemia Likely associated with CKD, cannot rule out mineral or vitamin def playing a role. -Hgb 11.2, Iron panel showing iron def, b12/folate wnl -Continue ferrous sulfate 325 mg EOD, Continue to monitor transfuse hgb<7      Abnormal CXR Etiology unclear, primary concern would be potential underlying malginancy -Non-emergent CT chest recommended, however patient transitioned to DNR-CC   GOC Due to continuing decline.  -Palliative care consulted for GOC and EOL discussion. Transitioned to DNR-CC. Patient does not qualify for hospice at this time -Patient will require a hospital bed after evaluation in the hospital
Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Catheterisation cardiac abnormal, Chest X-ray abnormal, Chest discomfort, Chest pain, Coronary artery occlusion
Clinical narrative: Hospital Course:    Patient is a 90 y.o. male patient of DO with a history of mild dementia but living independently presented to Hospital 12/05/2022 with chest discomfort radiating to both arms.  His symptoms had begun the day before but were less specific.  He was found to have ST elevation, albeit with Q waves across the anterior precordium.  Due to ongoing symptomatology he was taken to the cardiac catheterization lab where he underwent intervention to the LAD successfully.   He continues to have issues with sundowning, but now is in sinus rhythm and his renal function has normalized.  He was then discharged home 12/10/2022 with home health assistance.  He will also follow-up with cardiology.    Discharge Diagnoses:   Anterior STEMI Risk factors: HLD, CKD, Heart Score: 8. Presented with chest pain of unclear duration -Troponin 2,501, EKG with ST elevations V4/5/6, LHC mid/distal LAD showing complete occlusion Timi flow 0 -- > timi 3 flow after intervention.  -Continue eliquis, plavix, atorvistatin, lisinopril 5 mg    Paroxsymal A Fib. With RVR Likely in the setting of recent MI and volume depleted status -Received Lopressor IV 2.5 x 4 overnight with improvement of HR -transition from amio gtt to oral amio 200 mg BID, after risks and benefits discussion with family, will transition to 2.5mg of eliquis twice daily  -We will arrange follow-up with cardiology as outpatient locally,    Aspiration Pneumonitis In the setting of emesis, with potential chronic contributions -leukocytosis, with CXR changes per above -Transition to augmentin for 5 days therapy total, SLP consulted for swallow minor aspiration with strong cough reflex recommend pureed diet.    Urinary Retention Unclear etiology, possibly underlying chronic retention exacerbated by poor intake -Foley removed 12/09 -Plan: Will encourage patient to spontaneously void on his own, may require further workup if not -patient will f/u with known urologist, Dr.     CKD IV Baseline Cr 1.8-2.0, not on iHD -Cr at baseline -Continue to monitor   Acute Hypoxemic Respiratory Failure, improving In the setting of an aspiration event. -CXR showing retrocardiac opacities consistent with aspiration -continue supplemental O2 wean with goal sat >88%. Patient may need homegoing O2 Anemia Likely associated with CKD, cannot rule out mineral or vitamin def playing a role. -Hgb 11.2, Iron panel showing iron def, b12/folate wnl -Continue ferrous sulfate 325 mg EOD, Continue to monitor transfuse hgb<7      Abnormal CXR Etiology unclear, primary concern would be potential underlying malginancy -Non-emergent CT chest recommended, however patient transitioned to DNR-CC   GOC Due to continuing decline.  -Palliative care consulted for GOC and EOL discussion. Transitioned to DNR-CC. Patient does not qualify for hospice at this time -Patient will require a hospital bed after evaluation in the hospital
Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Delirium, Electrocardiogram Q waves, Electrocardiogram ST segment elevation, General physical health deterioration, Haemoglobin decreased
Clinical narrative: Hospital Course:    Patient is a 90 y.o. male patient of DO with a history of mild dementia but living independently presented to Hospital 12/05/2022 with chest discomfort radiating to both arms.  His symptoms had begun the day before but were less specific.  He was found to have ST elevation, albeit with Q waves across the anterior precordium.  Due to ongoing symptomatology he was taken to the cardiac catheterization lab where he underwent intervention to the LAD successfully.   He continues to have issues with sundowning, but now is in sinus rhythm and his renal function has normalized.  He was then discharged home 12/10/2022 with home health assistance.  He will also follow-up with cardiology.    Discharge Diagnoses:   Anterior STEMI Risk factors: HLD, CKD, Heart Score: 8. Presented with chest pain of unclear duration -Troponin 2,501, EKG with ST elevations V4/5/6, LHC mid/distal LAD showing complete occlusion Timi flow 0 -- > timi 3 flow after intervention.  -Continue eliquis, plavix, atorvistatin, lisinopril 5 mg    Paroxsymal A Fib. With RVR Likely in the setting of recent MI and volume depleted status -Received Lopressor IV 2.5 x 4 overnight with improvement of HR -transition from amio gtt to oral amio 200 mg BID, after risks and benefits discussion with family, will transition to 2.5mg of eliquis twice daily  -We will arrange follow-up with cardiology as outpatient locally,    Aspiration Pneumonitis In the setting of emesis, with potential chronic contributions -leukocytosis, with CXR changes per above -Transition to augmentin for 5 days therapy total, SLP consulted for swallow minor aspiration with strong cough reflex recommend pureed diet.    Urinary Retention Unclear etiology, possibly underlying chronic retention exacerbated by poor intake -Foley removed 12/09 -Plan: Will encourage patient to spontaneously void on his own, may require further workup if not -patient will f/u with known urologist, Dr.     CKD IV Baseline Cr 1.8-2.0, not on iHD -Cr at baseline -Continue to monitor   Acute Hypoxemic Respiratory Failure, improving In the setting of an aspiration event. -CXR showing retrocardiac opacities consistent with aspiration -continue supplemental O2 wean with goal sat >88%. Patient may need homegoing O2 Anemia Likely associated with CKD, cannot rule out mineral or vitamin def playing a role. -Hgb 11.2, Iron panel showing iron def, b12/folate wnl -Continue ferrous sulfate 325 mg EOD, Continue to monitor transfuse hgb<7      Abnormal CXR Etiology unclear, primary concern would be potential underlying malginancy -Non-emergent CT chest recommended, however patient transitioned to DNR-CC   GOC Due to continuing decline.  -Palliative care consulted for GOC and EOL discussion. Transitioned to DNR-CC. Patient does not qualify for hospice at this time -Patient will require a hospital bed after evaluation in the hospital
Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Hypophagia, Hypovolaemia, Interventional procedure, Iron deficiency, Leukocytosis
Clinical narrative: Hospital Course:    Patient is a 90 y.o. male patient of DO with a history of mild dementia but living independently presented to Hospital 12/05/2022 with chest discomfort radiating to both arms.  His symptoms had begun the day before but were less specific.  He was found to have ST elevation, albeit with Q waves across the anterior precordium.  Due to ongoing symptomatology he was taken to the cardiac catheterization lab where he underwent intervention to the LAD successfully.   He continues to have issues with sundowning, but now is in sinus rhythm and his renal function has normalized.  He was then discharged home 12/10/2022 with home health assistance.  He will also follow-up with cardiology.    Discharge Diagnoses:   Anterior STEMI Risk factors: HLD, CKD, Heart Score: 8. Presented with chest pain of unclear duration -Troponin 2,501, EKG with ST elevations V4/5/6, LHC mid/distal LAD showing complete occlusion Timi flow 0 -- > timi 3 flow after intervention.  -Continue eliquis, plavix, atorvistatin, lisinopril 5 mg    Paroxsymal A Fib. With RVR Likely in the setting of recent MI and volume depleted status -Received Lopressor IV 2.5 x 4 overnight with improvement of HR -transition from amio gtt to oral amio 200 mg BID, after risks and benefits discussion with family, will transition to 2.5mg of eliquis twice daily  -We will arrange follow-up with cardiology as outpatient locally,    Aspiration Pneumonitis In the setting of emesis, with potential chronic contributions -leukocytosis, with CXR changes per above -Transition to augmentin for 5 days therapy total, SLP consulted for swallow minor aspiration with strong cough reflex recommend pureed diet.    Urinary Retention Unclear etiology, possibly underlying chronic retention exacerbated by poor intake -Foley removed 12/09 -Plan: Will encourage patient to spontaneously void on his own, may require further workup if not -patient will f/u with known urologist, Dr.     CKD IV Baseline Cr 1.8-2.0, not on iHD -Cr at baseline -Continue to monitor   Acute Hypoxemic Respiratory Failure, improving In the setting of an aspiration event. -CXR showing retrocardiac opacities consistent with aspiration -continue supplemental O2 wean with goal sat >88%. Patient may need homegoing O2 Anemia Likely associated with CKD, cannot rule out mineral or vitamin def playing a role. -Hgb 11.2, Iron panel showing iron def, b12/folate wnl -Continue ferrous sulfate 325 mg EOD, Continue to monitor transfuse hgb<7      Abnormal CXR Etiology unclear, primary concern would be potential underlying malginancy -Non-emergent CT chest recommended, however patient transitioned to DNR-CC   GOC Due to continuing decline.  -Palliative care consulted for GOC and EOL discussion. Transitioned to DNR-CC. Patient does not qualify for hospice at this time -Patient will require a hospital bed after evaluation in the hospital
Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Limb discomfort, Lung opacity, Myocardial infarction, Pneumonitis aspiration, Renal impairment
Clinical narrative: Hospital Course:    Patient is a 90 y.o. male patient of DO with a history of mild dementia but living independently presented to Hospital 12/05/2022 with chest discomfort radiating to both arms.  His symptoms had begun the day before but were less specific.  He was found to have ST elevation, albeit with Q waves across the anterior precordium.  Due to ongoing symptomatology he was taken to the cardiac catheterization lab where he underwent intervention to the LAD successfully.   He continues to have issues with sundowning, but now is in sinus rhythm and his renal function has normalized.  He was then discharged home 12/10/2022 with home health assistance.  He will also follow-up with cardiology.    Discharge Diagnoses:   Anterior STEMI Risk factors: HLD, CKD, Heart Score: 8. Presented with chest pain of unclear duration -Troponin 2,501, EKG with ST elevations V4/5/6, LHC mid/distal LAD showing complete occlusion Timi flow 0 -- > timi 3 flow after intervention.  -Continue eliquis, plavix, atorvistatin, lisinopril 5 mg    Paroxsymal A Fib. With RVR Likely in the setting of recent MI and volume depleted status -Received Lopressor IV 2.5 x 4 overnight with improvement of HR -transition from amio gtt to oral amio 200 mg BID, after risks and benefits discussion with family, will transition to 2.5mg of eliquis twice daily  -We will arrange follow-up with cardiology as outpatient locally,    Aspiration Pneumonitis In the setting of emesis, with potential chronic contributions -leukocytosis, with CXR changes per above -Transition to augmentin for 5 days therapy total, SLP consulted for swallow minor aspiration with strong cough reflex recommend pureed diet.    Urinary Retention Unclear etiology, possibly underlying chronic retention exacerbated by poor intake -Foley removed 12/09 -Plan: Will encourage patient to spontaneously void on his own, may require further workup if not -patient will f/u with known urologist, Dr.     CKD IV Baseline Cr 1.8-2.0, not on iHD -Cr at baseline -Continue to monitor   Acute Hypoxemic Respiratory Failure, improving In the setting of an aspiration event. -CXR showing retrocardiac opacities consistent with aspiration -continue supplemental O2 wean with goal sat >88%. Patient may need homegoing O2 Anemia Likely associated with CKD, cannot rule out mineral or vitamin def playing a role. -Hgb 11.2, Iron panel showing iron def, b12/folate wnl -Continue ferrous sulfate 325 mg EOD, Continue to monitor transfuse hgb<7      Abnormal CXR Etiology unclear, primary concern would be potential underlying malginancy -Non-emergent CT chest recommended, however patient transitioned to DNR-CC   GOC Due to continuing decline.  -Palliative care consulted for GOC and EOL discussion. Transitioned to DNR-CC. Patient does not qualify for hospice at this time -Patient will require a hospital bed after evaluation in the hospital
Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Sinus rhythm, Troponin increased, Urinary retention, Vitamin B12 normal, Vomiting
Clinical narrative: Hospital Course:    Patient is a 90 y.o. male patient of DO with a history of mild dementia but living independently presented to Hospital 12/05/2022 with chest discomfort radiating to both arms.  His symptoms had begun the day before but were less specific.  He was found to have ST elevation, albeit with Q waves across the anterior precordium.  Due to ongoing symptomatology he was taken to the cardiac catheterization lab where he underwent intervention to the LAD successfully.   He continues to have issues with sundowning, but now is in sinus rhythm and his renal function has normalized.  He was then discharged home 12/10/2022 with home health assistance.  He will also follow-up with cardiology.    Discharge Diagnoses:   Anterior STEMI Risk factors: HLD, CKD, Heart Score: 8. Presented with chest pain of unclear duration -Troponin 2,501, EKG with ST elevations V4/5/6, LHC mid/distal LAD showing complete occlusion Timi flow 0 -- > timi 3 flow after intervention.  -Continue eliquis, plavix, atorvistatin, lisinopril 5 mg    Paroxsymal A Fib. With RVR Likely in the setting of recent MI and volume depleted status -Received Lopressor IV 2.5 x 4 overnight with improvement of HR -transition from amio gtt to oral amio 200 mg BID, after risks and benefits discussion with family, will transition to 2.5mg of eliquis twice daily  -We will arrange follow-up with cardiology as outpatient locally,    Aspiration Pneumonitis In the setting of emesis, with potential chronic contributions -leukocytosis, with CXR changes per above -Transition to augmentin for 5 days therapy total, SLP consulted for swallow minor aspiration with strong cough reflex recommend pureed diet.    Urinary Retention Unclear etiology, possibly underlying chronic retention exacerbated by poor intake -Foley removed 12/09 -Plan: Will encourage patient to spontaneously void on his own, may require further workup if not -patient will f/u with known urologist, Dr.     CKD IV Baseline Cr 1.8-2.0, not on iHD -Cr at baseline -Continue to monitor   Acute Hypoxemic Respiratory Failure, improving In the setting of an aspiration event. -CXR showing retrocardiac opacities consistent with aspiration -continue supplemental O2 wean with goal sat >88%. Patient may need homegoing O2 Anemia Likely associated with CKD, cannot rule out mineral or vitamin def playing a role. -Hgb 11.2, Iron panel showing iron def, b12/folate wnl -Continue ferrous sulfate 325 mg EOD, Continue to monitor transfuse hgb<7      Abnormal CXR Etiology unclear, primary concern would be potential underlying malginancy -Non-emergent CT chest recommended, however patient transitioned to DNR-CC   GOC Due to continuing decline.  -Palliative care consulted for GOC and EOL discussion. Transitioned to DNR-CC. Patient does not qualify for hospice at this time -Patient will require a hospital bed after evaluation in the hospital
Age: 44.0
Sex: M
Vaccine: COVID19-2
Symptoms: Product storage error
Clinical narrative: The patient was given a dose of the undiluted (Gray cap) Pfizer COVID-19 Bivalent booster that was not stored in an ultra-cold temperature freezer and was instead stored in the regular freezer (between -30 to -20 F). It was moved out of the regular freezer to the refrigerator after more than 3 weeks in the regular freezer. The doses were then used after more than 24 hours in the refrigerator. We have contacted Pfizer about this and according to their off-label studies they provided via PDF file, they are not able to support the temperature excursions that occurred. As per guidance, the recommendation is to re-vaccinate the individual with the full authorized dose of any Bivalent vaccine (either Pfizer or Moderna) and we have communicated with the patient for re-vaccination.
Age: 27.0
Sex: M
Vaccine: UNK
Symptoms: Injection site pain, Pain, Shoulder injury related to vaccine administration
Clinical narrative: Apparent Shoulder Injury Related to Vaccine Administration (SIRVA). Sharp Pain at certain rotations and general soreness currently at 17 days from injection. The injection was particularly painful
Age: 35.0
Sex: M
Vaccine: COVID19-2
Symptoms: Product storage error
Clinical narrative: The patient was given a dose of the undiluted (Gray cap) Pfizer COVID-19 Bivalent booster that was not stored in an ultra-cold temperature freezer and was instead stored in the regular freezer (between -30 to -20 F). It was moved out of the regular freezer to the refrigerator after more than 3 weeks in the regular freezer. The doses were then used after more than 24 hours in the refrigerator. We have contacted Pfizer about this and according to their off-label studies they provided via PDF file, they are not able to support the temperature excursions that occurred. As per guidance, the recommendation is to re-vaccinate the individual with the full authorized dose of any Bivalent vaccine (either Pfizer or Moderna) and we have communicated with the patient for re-vaccination.
Age: 5.0
Sex: M
Vaccine: COVID19-2
Symptoms: Incorrect product formulation administered
Clinical narrative: PEDIATRIC BIVALENT VACCINE INCORRECTLY ADMINISTERED AS A PRIMARY SERIES MONOVALENT DOSE
Age: 82.0
Sex: M
Vaccine: COVID19-2
Symptoms: Product storage error
Clinical narrative: Error: Improper Storage (ex. temp./location)-
Age: 47.0
Sex: M
Vaccine: COVID19-2
Symptoms: Product storage error
Clinical narrative: The patient was given a dose of the undiluted (Gray cap) Pfizer COVID-19 Bivalent booster that was not stored in an ultra-cold temperature freezer and was instead stored in the regular freezer (between -30 to -20 F). It was moved out of the regular freezer to the refrigerator after more than 3 weeks in the regular freezer. The doses were then used after more than 24 hours in the refrigerator. We have contacted Pfizer about this and according to their off-label studies they provided via PDF file, they are not able to support the temperature excursions that occurred. As per guidance, the recommendation is to re-vaccinate the individual with the full authorized dose of any Bivalent vaccine (either Pfizer or Moderna) and we have communicated with the patient for re-vaccination.
Age: 82.0
Sex: F
Vaccine: COVID19-2
Symptoms: Product storage error
Clinical narrative: Error: Improper Storage (ex. temp./location)-
Age: 44.0
Sex: M
Vaccine: FLU4
Symptoms: Blood pressure increased, Chest discomfort, Chills, Dyspnoea, Immediate post-injection reaction
Clinical narrative: Immediately after receiving the shot, felt tightness across my chest.  2 hours later, began to experience flu like symptoms.  Started running a fever and shivering in the bed.  highest fever was 102.  symptoms lasted 24 hours.    Other symptoms were slightly labored breathing, elevated blood pressure, and fluctuating O2 levels.  Tightness in the chest remains after fever and other symptoms have dissipated.
Age: 44.0
Sex: M
Vaccine: FLU4
Symptoms: Influenza like illness, Oxygen saturation abnormal, Pyrexia
Clinical narrative: Immediately after receiving the shot, felt tightness across my chest.  2 hours later, began to experience flu like symptoms.  Started running a fever and shivering in the bed.  highest fever was 102.  symptoms lasted 24 hours.    Other symptoms were slightly labored breathing, elevated blood pressure, and fluctuating O2 levels.  Tightness in the chest remains after fever and other symptoms have dissipated.
Age: 61.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Blood creatinine increased, Blood glucose normal, Blood lactic acid
Clinical narrative: Patient is a 61 y.o. female patient of MD with history of HTN, CAD, HFrEF, COPD who presented with dyspnea.   Acute Respiratory Failure w/Hypoxia - Resolved Multifactorial, including COVID, PNA, sepsis, AECOPD Initially required 4L NC, no baseline requirement CT Chest w/RUL infiltrate Aggressive pulmonary hygiene NIPPV ordered on admission for significant WOB Pulm/CC consulted Now stable on room air   Septic Shock - Resolved Present on admission: yes Etiology: PNA Criteria: tachycardia, tachypnea, fever, leukocytosis, source Evidence of end organ damage:  Initial lactic acid: 1.4 WBC 28, COVID + Resp PCR, Blood/sputum culture, urine AG, MRSA probe pending Given Rocephin/Azithro in ED Current antibiotic regimen: Rocephin Vasopressors/steroids: Levo off by 11/17   Covid-19 Virus Infection Date of onset of symptoms: 11/7 Symptoms present on admission: Cough, fever, malaise Date of covid positive test: 11/7 at MC Vaccination status: vaccinated, booster x2 Imaging: CT w/RUL infiltrate Oxygen requirements on admission: 4L Current oxygen requirements: Room air Medical therapy: Decadron, Cefepime and zithromax Consultants following: Pulm Special isolation end date: 11/18 Complete 10 day course of Decadron on discharge   AKI Likely pre-renal/ATN from shock vs COVID renal injury BUN/Cr 54/3.46, baseline WNL Limit nephrotoxins as able Monitor UOP, strict in/out Improving slowly; 2.54 on 11/17, 2.03 on 11/18 Monitor renal function  Elevated Troponin Asymptomatic, likely demand ischemia Initial trop 39 EKG w/o acute ischemic changes Monitor on tele Negative trend; no further cardiac work up at this time   COPD, w/acute exacerbation Secondary to COVID, PNA Scheduled MDI, tiotropium, Symbicort Steroids, abx as above Aggressive pulmonary hygiene Advair on discharge (based on coverage)   T2DM, non-insulin dependent Chronic, controlled BG 133, A1c 6.7 Home oral agents held on admission Accuchecks and SSI ordered Due to worsening, changed to insulin drip Now with low sugars so changing back to basal bolus insulin Resume home agents on discharge   HFrEF, w/o acute exacerbation NICM s/p dual chamber AICD placement Stable, clinically euvolemic  ECHO 2010: EF 45-50% Holding GDMT given shock Echo with EF 41%, mild MVR and TVR   Obesity BMI 33.01 Weight loss, lifestyle modification encouraged   Tobacco Use Disorder Smokes 1/2 PPD >3 minutes spent counseling cessation NRT while hospitalized
Age: 61.0
Sex: F
Vaccine: COVID19
Symptoms: Blood urea increased, COVID-19, Chronic obstructive pulmonary disease, Computerised tomogram thorax abnormal, Condition aggravated
Clinical narrative: Patient is a 61 y.o. female patient of MD with history of HTN, CAD, HFrEF, COPD who presented with dyspnea.   Acute Respiratory Failure w/Hypoxia - Resolved Multifactorial, including COVID, PNA, sepsis, AECOPD Initially required 4L NC, no baseline requirement CT Chest w/RUL infiltrate Aggressive pulmonary hygiene NIPPV ordered on admission for significant WOB Pulm/CC consulted Now stable on room air   Septic Shock - Resolved Present on admission: yes Etiology: PNA Criteria: tachycardia, tachypnea, fever, leukocytosis, source Evidence of end organ damage:  Initial lactic acid: 1.4 WBC 28, COVID + Resp PCR, Blood/sputum culture, urine AG, MRSA probe pending Given Rocephin/Azithro in ED Current antibiotic regimen: Rocephin Vasopressors/steroids: Levo off by 11/17   Covid-19 Virus Infection Date of onset of symptoms: 11/7 Symptoms present on admission: Cough, fever, malaise Date of covid positive test: 11/7 at MC Vaccination status: vaccinated, booster x2 Imaging: CT w/RUL infiltrate Oxygen requirements on admission: 4L Current oxygen requirements: Room air Medical therapy: Decadron, Cefepime and zithromax Consultants following: Pulm Special isolation end date: 11/18 Complete 10 day course of Decadron on discharge   AKI Likely pre-renal/ATN from shock vs COVID renal injury BUN/Cr 54/3.46, baseline WNL Limit nephrotoxins as able Monitor UOP, strict in/out Improving slowly; 2.54 on 11/17, 2.03 on 11/18 Monitor renal function  Elevated Troponin Asymptomatic, likely demand ischemia Initial trop 39 EKG w/o acute ischemic changes Monitor on tele Negative trend; no further cardiac work up at this time   COPD, w/acute exacerbation Secondary to COVID, PNA Scheduled MDI, tiotropium, Symbicort Steroids, abx as above Aggressive pulmonary hygiene Advair on discharge (based on coverage)   T2DM, non-insulin dependent Chronic, controlled BG 133, A1c 6.7 Home oral agents held on admission Accuchecks and SSI ordered Due to worsening, changed to insulin drip Now with low sugars so changing back to basal bolus insulin Resume home agents on discharge   HFrEF, w/o acute exacerbation NICM s/p dual chamber AICD placement Stable, clinically euvolemic  ECHO 2010: EF 45-50% Holding GDMT given shock Echo with EF 41%, mild MVR and TVR   Obesity BMI 33.01 Weight loss, lifestyle modification encouraged   Tobacco Use Disorder Smokes 1/2 PPD >3 minutes spent counseling cessation NRT while hospitalized
Age: 61.0
Sex: F
Vaccine: COVID19
Symptoms: Cough, Dyspnoea, Echocardiogram, Electrocardiogram normal, Glycosylated haemoglobin normal
Clinical narrative: Patient is a 61 y.o. female patient of MD with history of HTN, CAD, HFrEF, COPD who presented with dyspnea.   Acute Respiratory Failure w/Hypoxia - Resolved Multifactorial, including COVID, PNA, sepsis, AECOPD Initially required 4L NC, no baseline requirement CT Chest w/RUL infiltrate Aggressive pulmonary hygiene NIPPV ordered on admission for significant WOB Pulm/CC consulted Now stable on room air   Septic Shock - Resolved Present on admission: yes Etiology: PNA Criteria: tachycardia, tachypnea, fever, leukocytosis, source Evidence of end organ damage:  Initial lactic acid: 1.4 WBC 28, COVID + Resp PCR, Blood/sputum culture, urine AG, MRSA probe pending Given Rocephin/Azithro in ED Current antibiotic regimen: Rocephin Vasopressors/steroids: Levo off by 11/17   Covid-19 Virus Infection Date of onset of symptoms: 11/7 Symptoms present on admission: Cough, fever, malaise Date of covid positive test: 11/7 at MC Vaccination status: vaccinated, booster x2 Imaging: CT w/RUL infiltrate Oxygen requirements on admission: 4L Current oxygen requirements: Room air Medical therapy: Decadron, Cefepime and zithromax Consultants following: Pulm Special isolation end date: 11/18 Complete 10 day course of Decadron on discharge   AKI Likely pre-renal/ATN from shock vs COVID renal injury BUN/Cr 54/3.46, baseline WNL Limit nephrotoxins as able Monitor UOP, strict in/out Improving slowly; 2.54 on 11/17, 2.03 on 11/18 Monitor renal function  Elevated Troponin Asymptomatic, likely demand ischemia Initial trop 39 EKG w/o acute ischemic changes Monitor on tele Negative trend; no further cardiac work up at this time   COPD, w/acute exacerbation Secondary to COVID, PNA Scheduled MDI, tiotropium, Symbicort Steroids, abx as above Aggressive pulmonary hygiene Advair on discharge (based on coverage)   T2DM, non-insulin dependent Chronic, controlled BG 133, A1c 6.7 Home oral agents held on admission Accuchecks and SSI ordered Due to worsening, changed to insulin drip Now with low sugars so changing back to basal bolus insulin Resume home agents on discharge   HFrEF, w/o acute exacerbation NICM s/p dual chamber AICD placement Stable, clinically euvolemic  ECHO 2010: EF 45-50% Holding GDMT given shock Echo with EF 41%, mild MVR and TVR   Obesity BMI 33.01 Weight loss, lifestyle modification encouraged   Tobacco Use Disorder Smokes 1/2 PPD >3 minutes spent counseling cessation NRT while hospitalized
Age: 61.0
Sex: F
Vaccine: COVID19
Symptoms: Leukocytosis, Lung infiltration, Malaise, Myocardial ischaemia, Pneumonia
Clinical narrative: Patient is a 61 y.o. female patient of MD with history of HTN, CAD, HFrEF, COPD who presented with dyspnea.   Acute Respiratory Failure w/Hypoxia - Resolved Multifactorial, including COVID, PNA, sepsis, AECOPD Initially required 4L NC, no baseline requirement CT Chest w/RUL infiltrate Aggressive pulmonary hygiene NIPPV ordered on admission for significant WOB Pulm/CC consulted Now stable on room air   Septic Shock - Resolved Present on admission: yes Etiology: PNA Criteria: tachycardia, tachypnea, fever, leukocytosis, source Evidence of end organ damage:  Initial lactic acid: 1.4 WBC 28, COVID + Resp PCR, Blood/sputum culture, urine AG, MRSA probe pending Given Rocephin/Azithro in ED Current antibiotic regimen: Rocephin Vasopressors/steroids: Levo off by 11/17   Covid-19 Virus Infection Date of onset of symptoms: 11/7 Symptoms present on admission: Cough, fever, malaise Date of covid positive test: 11/7 at MC Vaccination status: vaccinated, booster x2 Imaging: CT w/RUL infiltrate Oxygen requirements on admission: 4L Current oxygen requirements: Room air Medical therapy: Decadron, Cefepime and zithromax Consultants following: Pulm Special isolation end date: 11/18 Complete 10 day course of Decadron on discharge   AKI Likely pre-renal/ATN from shock vs COVID renal injury BUN/Cr 54/3.46, baseline WNL Limit nephrotoxins as able Monitor UOP, strict in/out Improving slowly; 2.54 on 11/17, 2.03 on 11/18 Monitor renal function  Elevated Troponin Asymptomatic, likely demand ischemia Initial trop 39 EKG w/o acute ischemic changes Monitor on tele Negative trend; no further cardiac work up at this time   COPD, w/acute exacerbation Secondary to COVID, PNA Scheduled MDI, tiotropium, Symbicort Steroids, abx as above Aggressive pulmonary hygiene Advair on discharge (based on coverage)   T2DM, non-insulin dependent Chronic, controlled BG 133, A1c 6.7 Home oral agents held on admission Accuchecks and SSI ordered Due to worsening, changed to insulin drip Now with low sugars so changing back to basal bolus insulin Resume home agents on discharge   HFrEF, w/o acute exacerbation NICM s/p dual chamber AICD placement Stable, clinically euvolemic  ECHO 2010: EF 45-50% Holding GDMT given shock Echo with EF 41%, mild MVR and TVR   Obesity BMI 33.01 Weight loss, lifestyle modification encouraged   Tobacco Use Disorder Smokes 1/2 PPD >3 minutes spent counseling cessation NRT while hospitalized
Age: 61.0
Sex: F
Vaccine: COVID19
Symptoms: Pyrexia, Renal injury, Renal tubular necrosis, SARS-CoV-2 test positive, Sepsis
Clinical narrative: Patient is a 61 y.o. female patient of MD with history of HTN, CAD, HFrEF, COPD who presented with dyspnea.   Acute Respiratory Failure w/Hypoxia - Resolved Multifactorial, including COVID, PNA, sepsis, AECOPD Initially required 4L NC, no baseline requirement CT Chest w/RUL infiltrate Aggressive pulmonary hygiene NIPPV ordered on admission for significant WOB Pulm/CC consulted Now stable on room air   Septic Shock - Resolved Present on admission: yes Etiology: PNA Criteria: tachycardia, tachypnea, fever, leukocytosis, source Evidence of end organ damage:  Initial lactic acid: 1.4 WBC 28, COVID + Resp PCR, Blood/sputum culture, urine AG, MRSA probe pending Given Rocephin/Azithro in ED Current antibiotic regimen: Rocephin Vasopressors/steroids: Levo off by 11/17   Covid-19 Virus Infection Date of onset of symptoms: 11/7 Symptoms present on admission: Cough, fever, malaise Date of covid positive test: 11/7 at MC Vaccination status: vaccinated, booster x2 Imaging: CT w/RUL infiltrate Oxygen requirements on admission: 4L Current oxygen requirements: Room air Medical therapy: Decadron, Cefepime and zithromax Consultants following: Pulm Special isolation end date: 11/18 Complete 10 day course of Decadron on discharge   AKI Likely pre-renal/ATN from shock vs COVID renal injury BUN/Cr 54/3.46, baseline WNL Limit nephrotoxins as able Monitor UOP, strict in/out Improving slowly; 2.54 on 11/17, 2.03 on 11/18 Monitor renal function  Elevated Troponin Asymptomatic, likely demand ischemia Initial trop 39 EKG w/o acute ischemic changes Monitor on tele Negative trend; no further cardiac work up at this time   COPD, w/acute exacerbation Secondary to COVID, PNA Scheduled MDI, tiotropium, Symbicort Steroids, abx as above Aggressive pulmonary hygiene Advair on discharge (based on coverage)   T2DM, non-insulin dependent Chronic, controlled BG 133, A1c 6.7 Home oral agents held on admission Accuchecks and SSI ordered Due to worsening, changed to insulin drip Now with low sugars so changing back to basal bolus insulin Resume home agents on discharge   HFrEF, w/o acute exacerbation NICM s/p dual chamber AICD placement Stable, clinically euvolemic  ECHO 2010: EF 45-50% Holding GDMT given shock Echo with EF 41%, mild MVR and TVR   Obesity BMI 33.01 Weight loss, lifestyle modification encouraged   Tobacco Use Disorder Smokes 1/2 PPD >3 minutes spent counseling cessation NRT while hospitalized
Age: 61.0
Sex: F
Vaccine: COVID19
Symptoms: Septic shock, Shock, Tachycardia, Tachypnoea, Troponin increased
Clinical narrative: Patient is a 61 y.o. female patient of MD with history of HTN, CAD, HFrEF, COPD who presented with dyspnea.   Acute Respiratory Failure w/Hypoxia - Resolved Multifactorial, including COVID, PNA, sepsis, AECOPD Initially required 4L NC, no baseline requirement CT Chest w/RUL infiltrate Aggressive pulmonary hygiene NIPPV ordered on admission for significant WOB Pulm/CC consulted Now stable on room air   Septic Shock - Resolved Present on admission: yes Etiology: PNA Criteria: tachycardia, tachypnea, fever, leukocytosis, source Evidence of end organ damage:  Initial lactic acid: 1.4 WBC 28, COVID + Resp PCR, Blood/sputum culture, urine AG, MRSA probe pending Given Rocephin/Azithro in ED Current antibiotic regimen: Rocephin Vasopressors/steroids: Levo off by 11/17   Covid-19 Virus Infection Date of onset of symptoms: 11/7 Symptoms present on admission: Cough, fever, malaise Date of covid positive test: 11/7 at MC Vaccination status: vaccinated, booster x2 Imaging: CT w/RUL infiltrate Oxygen requirements on admission: 4L Current oxygen requirements: Room air Medical therapy: Decadron, Cefepime and zithromax Consultants following: Pulm Special isolation end date: 11/18 Complete 10 day course of Decadron on discharge   AKI Likely pre-renal/ATN from shock vs COVID renal injury BUN/Cr 54/3.46, baseline WNL Limit nephrotoxins as able Monitor UOP, strict in/out Improving slowly; 2.54 on 11/17, 2.03 on 11/18 Monitor renal function  Elevated Troponin Asymptomatic, likely demand ischemia Initial trop 39 EKG w/o acute ischemic changes Monitor on tele Negative trend; no further cardiac work up at this time   COPD, w/acute exacerbation Secondary to COVID, PNA Scheduled MDI, tiotropium, Symbicort Steroids, abx as above Aggressive pulmonary hygiene Advair on discharge (based on coverage)   T2DM, non-insulin dependent Chronic, controlled BG 133, A1c 6.7 Home oral agents held on admission Accuchecks and SSI ordered Due to worsening, changed to insulin drip Now with low sugars so changing back to basal bolus insulin Resume home agents on discharge   HFrEF, w/o acute exacerbation NICM s/p dual chamber AICD placement Stable, clinically euvolemic  ECHO 2010: EF 45-50% Holding GDMT given shock Echo with EF 41%, mild MVR and TVR   Obesity BMI 33.01 Weight loss, lifestyle modification encouraged   Tobacco Use Disorder Smokes 1/2 PPD >3 minutes spent counseling cessation NRT while hospitalized
Age: 61.0
Sex: F
Vaccine: COVID19
Symptoms: White blood cell count increased
Clinical narrative: Patient is a 61 y.o. female patient of MD with history of HTN, CAD, HFrEF, COPD who presented with dyspnea.   Acute Respiratory Failure w/Hypoxia - Resolved Multifactorial, including COVID, PNA, sepsis, AECOPD Initially required 4L NC, no baseline requirement CT Chest w/RUL infiltrate Aggressive pulmonary hygiene NIPPV ordered on admission for significant WOB Pulm/CC consulted Now stable on room air   Septic Shock - Resolved Present on admission: yes Etiology: PNA Criteria: tachycardia, tachypnea, fever, leukocytosis, source Evidence of end organ damage:  Initial lactic acid: 1.4 WBC 28, COVID + Resp PCR, Blood/sputum culture, urine AG, MRSA probe pending Given Rocephin/Azithro in ED Current antibiotic regimen: Rocephin Vasopressors/steroids: Levo off by 11/17   Covid-19 Virus Infection Date of onset of symptoms: 11/7 Symptoms present on admission: Cough, fever, malaise Date of covid positive test: 11/7 at MC Vaccination status: vaccinated, booster x2 Imaging: CT w/RUL infiltrate Oxygen requirements on admission: 4L Current oxygen requirements: Room air Medical therapy: Decadron, Cefepime and zithromax Consultants following: Pulm Special isolation end date: 11/18 Complete 10 day course of Decadron on discharge   AKI Likely pre-renal/ATN from shock vs COVID renal injury BUN/Cr 54/3.46, baseline WNL Limit nephrotoxins as able Monitor UOP, strict in/out Improving slowly; 2.54 on 11/17, 2.03 on 11/18 Monitor renal function  Elevated Troponin Asymptomatic, likely demand ischemia Initial trop 39 EKG w/o acute ischemic changes Monitor on tele Negative trend; no further cardiac work up at this time   COPD, w/acute exacerbation Secondary to COVID, PNA Scheduled MDI, tiotropium, Symbicort Steroids, abx as above Aggressive pulmonary hygiene Advair on discharge (based on coverage)   T2DM, non-insulin dependent Chronic, controlled BG 133, A1c 6.7 Home oral agents held on admission Accuchecks and SSI ordered Due to worsening, changed to insulin drip Now with low sugars so changing back to basal bolus insulin Resume home agents on discharge   HFrEF, w/o acute exacerbation NICM s/p dual chamber AICD placement Stable, clinically euvolemic  ECHO 2010: EF 45-50% Holding GDMT given shock Echo with EF 41%, mild MVR and TVR   Obesity BMI 33.01 Weight loss, lifestyle modification encouraged   Tobacco Use Disorder Smokes 1/2 PPD >3 minutes spent counseling cessation NRT while hospitalized
Age: 69.0
Sex: F
Vaccine: COVID19-2
Symptoms: Product storage error
Clinical narrative: Error: Improper Storage (ex. temp./location)-