chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 79.0
Sex: M
Vaccine: COVID19-2
Symptoms: White blood cell count increased
Clinical narrative: Patient is a 80 y.o. male patient of MD with history of BPH, COPD, CAD, dyslipidemia, hypertension, OSA on CPAP presented to Hospital with chest pain and shortness of breath.   Chest pain Acute on top of chronic hypoxic respiratory failure COPD  COVID 19 infection Possible aspiration pneumonia Bilateral pleural effusion CXR showed small bilateral pleural effusion with bibasilar opacity could be aspiration/pneumonia CT pulmonary arteries was negative for PE, shows moderate emphysema and possible of aspiration or infection WBC on admission 11.9 Patient is COVID 19 positive Blood cultures negative to date  Continue O2 support, currently on 4  L Infectious disease consult Cont Continue Decadron, remdesivir Continue bronchodilators, nebs as needed IV Lasix 20 mg once on 11/29  SLP to rule out aspiration, negative for aspiration ID Dr okay with discharge, discharged home 3 days course of dexamethasone     CAD with previous stenting Troponin negative on admission, BNP 300s Continue Ranexa, Plavix, Imdur and statin Continue oral Lasix Echo pending   Hypertension Continue metoprolol, lisinopril   Dyslipidemia Continue statin   BPH  continue finasteride and Flomax   GERD Continue PPI   Morbid obesity BMI 40.34 Lifestyle modification counseled to the patient.   Hypomagnesemia Hypophosphatemia Rellete as needed
Age: 22.0
Sex: F
Vaccine: FLUC4
Symptoms: Urticaria
Clinical narrative: Employee returned to the Employee Health Office with generalized hives one day after receiving the flu vaccine in the Employee Health Office. She states the hives began the same day as receiving the vaccine and she took Benadryl but the hives did not improve. She was taken to the ER and given Benadryl. After several days the hives began to resolve.
Age: 88.0
Sex: F
Vaccine: COVID19-2
Symptoms: Brain fog, COVID-19, Chest discomfort, Fatigue, Productive cough
Clinical narrative: Patient is a 89 y.o. female patient of MD with history of Dementia, CAD, PE/DVT, Hypertension, CKD, Emphysema, GERD, Anxiety, OSA presented to Hospital with fatigue, cough and fevers.   S: Stable on room air without dyspnea, mild productive cough, eating well, up and down to the bathroom. She has multiple concerns including about mental fogging, upper chest discomfort with coughing, sciatica but ultimately agrees she is stable to go home. Discharge plans discussed in detail with her daughter by phone.   Covid-19 Virus Infection Date of onset of symptoms: 11/13/23 Symptoms present on admission: fatigue, cough, fever  Date of covid positive test: 11/17/23 Vaccination status: vaccinated Imaging: CXR showed increased bibasilar opacities, right greater than left, are suspicious for small pleural effusions with adjacent airspace disease Oxygen requirements on admission: 2L/NC Current oxygen requirements: RA Medical therapy: Started remdesivir and steroids 11/17, stopped 11/18 due to resolved oxygen requirement Consultants following: none Anticipated special isolation end date: 11/24   Sepsis due to viral pneumonia, POA Acute respiratory failure, resolved Patient presented with 4 days of cough and worsening SOB Suspect viral pneumonia as positive for COVID  Initial T 102 but WBC normal at 8.05, PCT normal at 0.29 Not on oxygen at home but was requiring 2L/NC on admit CXR showed Increased bibasilar opacities, right greater than left, are suspicious for small pleural effusions with adjacent airspace disease  Received a dose of IV Rocephin and Zithromax in the ER; doubt secondary bacterial pnuemonia but with concurrent mild COPD exacerbation reasonable to complete course of azithromycin and steroids as below Scheduled Mucinex, prn tessalon   Elevated troponin Troponis are chronically elevated, 80-113 on previous admissions  She has had some chest discomfort across the top of her chest with coughing, re-created by palpation and seems MSK in nature Patient with acute illness and history of CKD Troponins 165 =>160 with a Delta difference of -3 EKG consistent with previous EKGs on file, without acute findings She recently had a CCTA (07/2023) with CAD-RADS 1and minimal stenosis Monitor on tele   COPD with acute exacerbation Listed dx of emphysema, no prior PFT available, not on inhalers at home. Added PRN Albuterol inhaler  No longer qualifies for directed COVID therapy due to resolved oxygen requirement, but reasonable to complete a course of prednisone/azithro for concurrent mild COPD exacerbation Consider outpt PFT   CKD 3 Baseline Cr ~1.2 Cr at 1.4 on admission, 1.1 on repeat Avoid nephrotoxic medications  Pulmonary emboli History of DVT and recent PE (7/19/23) Continue home Eliquis    Lewey body dementia Follows with Dr (neuro) Continue home galantamine   Lumbar spinal stenosis with chronic LLE pain Since Knee replacement 3/2022 Continue home gabapentin and Tylenol   OSA Compliant with nightly CPAP
Age: 88.0
Sex: F
Vaccine: COVID19-2
Symptoms: Pyrexia, SARS-CoV-2 test positive, Sciatica
Clinical narrative: Patient is a 89 y.o. female patient of MD with history of Dementia, CAD, PE/DVT, Hypertension, CKD, Emphysema, GERD, Anxiety, OSA presented to Hospital with fatigue, cough and fevers.   S: Stable on room air without dyspnea, mild productive cough, eating well, up and down to the bathroom. She has multiple concerns including about mental fogging, upper chest discomfort with coughing, sciatica but ultimately agrees she is stable to go home. Discharge plans discussed in detail with her daughter by phone.   Covid-19 Virus Infection Date of onset of symptoms: 11/13/23 Symptoms present on admission: fatigue, cough, fever  Date of covid positive test: 11/17/23 Vaccination status: vaccinated Imaging: CXR showed increased bibasilar opacities, right greater than left, are suspicious for small pleural effusions with adjacent airspace disease Oxygen requirements on admission: 2L/NC Current oxygen requirements: RA Medical therapy: Started remdesivir and steroids 11/17, stopped 11/18 due to resolved oxygen requirement Consultants following: none Anticipated special isolation end date: 11/24   Sepsis due to viral pneumonia, POA Acute respiratory failure, resolved Patient presented with 4 days of cough and worsening SOB Suspect viral pneumonia as positive for COVID  Initial T 102 but WBC normal at 8.05, PCT normal at 0.29 Not on oxygen at home but was requiring 2L/NC on admit CXR showed Increased bibasilar opacities, right greater than left, are suspicious for small pleural effusions with adjacent airspace disease  Received a dose of IV Rocephin and Zithromax in the ER; doubt secondary bacterial pnuemonia but with concurrent mild COPD exacerbation reasonable to complete course of azithromycin and steroids as below Scheduled Mucinex, prn tessalon   Elevated troponin Troponis are chronically elevated, 80-113 on previous admissions  She has had some chest discomfort across the top of her chest with coughing, re-created by palpation and seems MSK in nature Patient with acute illness and history of CKD Troponins 165 =>160 with a Delta difference of -3 EKG consistent with previous EKGs on file, without acute findings She recently had a CCTA (07/2023) with CAD-RADS 1and minimal stenosis Monitor on tele   COPD with acute exacerbation Listed dx of emphysema, no prior PFT available, not on inhalers at home. Added PRN Albuterol inhaler  No longer qualifies for directed COVID therapy due to resolved oxygen requirement, but reasonable to complete a course of prednisone/azithro for concurrent mild COPD exacerbation Consider outpt PFT   CKD 3 Baseline Cr ~1.2 Cr at 1.4 on admission, 1.1 on repeat Avoid nephrotoxic medications  Pulmonary emboli History of DVT and recent PE (7/19/23) Continue home Eliquis    Lewey body dementia Follows with Dr (neuro) Continue home galantamine   Lumbar spinal stenosis with chronic LLE pain Since Knee replacement 3/2022 Continue home gabapentin and Tylenol   OSA Compliant with nightly CPAP
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Alanine aminotransferase, Aspartate aminotransferase, Blood alkaline phosphatase normal
Clinical narrative: Patient is a 72 y.o. female patient of DO with history of HTN, CKD, DM 2, GERD, diabetic neuropathy, HLD, CHF (unknown LVEF) who presented to Hospital with generalized fatigue, malaise, myalgias and exertional shortness of breath. She was found to be COVID positive. Placed on oxygen, which was weaned during admission. She was also treated with Remdesivir and steroids. Remdesivir stopped at discharge, but patient sent home with script to complete total of 10 days of steroids. Off oxygen for more than 24 hours at time of discharge with improvement in shortness of breath. She did have an elevation in liver enzymes, likely 2/2 to infectious process. This improved during admission. AKI on CKD, so lisinopril was held. No need to nephrology consult at this time. Imaging did find a mass of the upper pole of the right kidney. Patient would benefit from follow up MRI outpatient.   While admitted, the patient was stable and clinically improved. They were medically stable at time of discharge, and their hospital problems are detailed below.   Acute hypoxic respiratory failure, resolved COVID-19 pneumonia Patient was hypoxic to lowmid 80s on arrival to ED on room air CXR on admission notable for minimal bibasilar opacities with cardiomegaly and a probable hiatal hernia Blood cultures NGTD Urine strep negative Urine Legionella negative CRP, ferritin WNL SORA Decadron 6 mg IV daily, transition to PO dexamethasone to complete 10 day course Stop Remdesivir 100 mg IV on discharge ID consulted, appreciate recs Bronchodilators and antipyretics as needed Maintain on enhanced droplet precautions Supportive care   Transaminitis, improving Suspect transaminitis likely secondary to acute viral process AST: ALT of 67: 54 ALP of 117 and T. bili of 0.4 Hold home Statin Monitor   AKI on CKD, stable Baseline GFR appears to be between 3040; currently at 26 BNP 1952, does not appear to be volume overloaded Weight stable (232 lbs baseline) Hold home Lasix 20 mg p.o. daily in interim Avoid nephrotoxic agents as able Renally dose medications Monitor renal function If fails to improve consider obtaining urine electrolytes, renal ultrasound and nephrology consult   Right kidney incidentaloma CT abdomen pelvis without contrast notable for complex low-attenuation mass of the upper pole of the right kidney, question a complex cyst versus solid mass Consider pre and postcontrast MRI of the kidneys outpatient   HTN Not noted to be on home oral antihypertensives As needed hydralazine Monitor BP   HLD Continue Zetia Hold home statin in setting of transaminitis   DM2 Hold home oral hypoglycemic agents Lantus and Humalog SSI POCT glucose
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Blood bilirubin normal, Blood culture negative, Brain natriuretic peptide increased, C-reactive protein normal, COVID-19
Clinical narrative: Patient is a 72 y.o. female patient of DO with history of HTN, CKD, DM 2, GERD, diabetic neuropathy, HLD, CHF (unknown LVEF) who presented to Hospital with generalized fatigue, malaise, myalgias and exertional shortness of breath. She was found to be COVID positive. Placed on oxygen, which was weaned during admission. She was also treated with Remdesivir and steroids. Remdesivir stopped at discharge, but patient sent home with script to complete total of 10 days of steroids. Off oxygen for more than 24 hours at time of discharge with improvement in shortness of breath. She did have an elevation in liver enzymes, likely 2/2 to infectious process. This improved during admission. AKI on CKD, so lisinopril was held. No need to nephrology consult at this time. Imaging did find a mass of the upper pole of the right kidney. Patient would benefit from follow up MRI outpatient.   While admitted, the patient was stable and clinically improved. They were medically stable at time of discharge, and their hospital problems are detailed below.   Acute hypoxic respiratory failure, resolved COVID-19 pneumonia Patient was hypoxic to lowmid 80s on arrival to ED on room air CXR on admission notable for minimal bibasilar opacities with cardiomegaly and a probable hiatal hernia Blood cultures NGTD Urine strep negative Urine Legionella negative CRP, ferritin WNL SORA Decadron 6 mg IV daily, transition to PO dexamethasone to complete 10 day course Stop Remdesivir 100 mg IV on discharge ID consulted, appreciate recs Bronchodilators and antipyretics as needed Maintain on enhanced droplet precautions Supportive care   Transaminitis, improving Suspect transaminitis likely secondary to acute viral process AST: ALT of 67: 54 ALP of 117 and T. bili of 0.4 Hold home Statin Monitor   AKI on CKD, stable Baseline GFR appears to be between 3040; currently at 26 BNP 1952, does not appear to be volume overloaded Weight stable (232 lbs baseline) Hold home Lasix 20 mg p.o. daily in interim Avoid nephrotoxic agents as able Renally dose medications Monitor renal function If fails to improve consider obtaining urine electrolytes, renal ultrasound and nephrology consult   Right kidney incidentaloma CT abdomen pelvis without contrast notable for complex low-attenuation mass of the upper pole of the right kidney, question a complex cyst versus solid mass Consider pre and postcontrast MRI of the kidneys outpatient   HTN Not noted to be on home oral antihypertensives As needed hydralazine Monitor BP   HLD Continue Zetia Hold home statin in setting of transaminitis   DM2 Hold home oral hypoglycemic agents Lantus and Humalog SSI POCT glucose
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Cardiomegaly, Chest X-ray abnormal, Computerised tomogram abdomen abnormal, Dyspnoea
Clinical narrative: Patient is a 72 y.o. female patient of DO with history of HTN, CKD, DM 2, GERD, diabetic neuropathy, HLD, CHF (unknown LVEF) who presented to Hospital with generalized fatigue, malaise, myalgias and exertional shortness of breath. She was found to be COVID positive. Placed on oxygen, which was weaned during admission. She was also treated with Remdesivir and steroids. Remdesivir stopped at discharge, but patient sent home with script to complete total of 10 days of steroids. Off oxygen for more than 24 hours at time of discharge with improvement in shortness of breath. She did have an elevation in liver enzymes, likely 2/2 to infectious process. This improved during admission. AKI on CKD, so lisinopril was held. No need to nephrology consult at this time. Imaging did find a mass of the upper pole of the right kidney. Patient would benefit from follow up MRI outpatient.   While admitted, the patient was stable and clinically improved. They were medically stable at time of discharge, and their hospital problems are detailed below.   Acute hypoxic respiratory failure, resolved COVID-19 pneumonia Patient was hypoxic to lowmid 80s on arrival to ED on room air CXR on admission notable for minimal bibasilar opacities with cardiomegaly and a probable hiatal hernia Blood cultures NGTD Urine strep negative Urine Legionella negative CRP, ferritin WNL SORA Decadron 6 mg IV daily, transition to PO dexamethasone to complete 10 day course Stop Remdesivir 100 mg IV on discharge ID consulted, appreciate recs Bronchodilators and antipyretics as needed Maintain on enhanced droplet precautions Supportive care   Transaminitis, improving Suspect transaminitis likely secondary to acute viral process AST: ALT of 67: 54 ALP of 117 and T. bili of 0.4 Hold home Statin Monitor   AKI on CKD, stable Baseline GFR appears to be between 3040; currently at 26 BNP 1952, does not appear to be volume overloaded Weight stable (232 lbs baseline) Hold home Lasix 20 mg p.o. daily in interim Avoid nephrotoxic agents as able Renally dose medications Monitor renal function If fails to improve consider obtaining urine electrolytes, renal ultrasound and nephrology consult   Right kidney incidentaloma CT abdomen pelvis without contrast notable for complex low-attenuation mass of the upper pole of the right kidney, question a complex cyst versus solid mass Consider pre and postcontrast MRI of the kidneys outpatient   HTN Not noted to be on home oral antihypertensives As needed hydralazine Monitor BP   HLD Continue Zetia Hold home statin in setting of transaminitis   DM2 Hold home oral hypoglycemic agents Lantus and Humalog SSI POCT glucose
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Dyspnoea exertional, Fatigue, Glomerular filtration rate, Hepatic enzyme increased, Hiatus hernia
Clinical narrative: Patient is a 72 y.o. female patient of DO with history of HTN, CKD, DM 2, GERD, diabetic neuropathy, HLD, CHF (unknown LVEF) who presented to Hospital with generalized fatigue, malaise, myalgias and exertional shortness of breath. She was found to be COVID positive. Placed on oxygen, which was weaned during admission. She was also treated with Remdesivir and steroids. Remdesivir stopped at discharge, but patient sent home with script to complete total of 10 days of steroids. Off oxygen for more than 24 hours at time of discharge with improvement in shortness of breath. She did have an elevation in liver enzymes, likely 2/2 to infectious process. This improved during admission. AKI on CKD, so lisinopril was held. No need to nephrology consult at this time. Imaging did find a mass of the upper pole of the right kidney. Patient would benefit from follow up MRI outpatient.   While admitted, the patient was stable and clinically improved. They were medically stable at time of discharge, and their hospital problems are detailed below.   Acute hypoxic respiratory failure, resolved COVID-19 pneumonia Patient was hypoxic to lowmid 80s on arrival to ED on room air CXR on admission notable for minimal bibasilar opacities with cardiomegaly and a probable hiatal hernia Blood cultures NGTD Urine strep negative Urine Legionella negative CRP, ferritin WNL SORA Decadron 6 mg IV daily, transition to PO dexamethasone to complete 10 day course Stop Remdesivir 100 mg IV on discharge ID consulted, appreciate recs Bronchodilators and antipyretics as needed Maintain on enhanced droplet precautions Supportive care   Transaminitis, improving Suspect transaminitis likely secondary to acute viral process AST: ALT of 67: 54 ALP of 117 and T. bili of 0.4 Hold home Statin Monitor   AKI on CKD, stable Baseline GFR appears to be between 3040; currently at 26 BNP 1952, does not appear to be volume overloaded Weight stable (232 lbs baseline) Hold home Lasix 20 mg p.o. daily in interim Avoid nephrotoxic agents as able Renally dose medications Monitor renal function If fails to improve consider obtaining urine electrolytes, renal ultrasound and nephrology consult   Right kidney incidentaloma CT abdomen pelvis without contrast notable for complex low-attenuation mass of the upper pole of the right kidney, question a complex cyst versus solid mass Consider pre and postcontrast MRI of the kidneys outpatient   HTN Not noted to be on home oral antihypertensives As needed hydralazine Monitor BP   HLD Continue Zetia Hold home statin in setting of transaminitis   DM2 Hold home oral hypoglycemic agents Lantus and Humalog SSI POCT glucose
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Hypertransaminasaemia, Hypoxia, Imaging procedure abnormal, Legionella test, Lung opacity
Clinical narrative: Patient is a 72 y.o. female patient of DO with history of HTN, CKD, DM 2, GERD, diabetic neuropathy, HLD, CHF (unknown LVEF) who presented to Hospital with generalized fatigue, malaise, myalgias and exertional shortness of breath. She was found to be COVID positive. Placed on oxygen, which was weaned during admission. She was also treated with Remdesivir and steroids. Remdesivir stopped at discharge, but patient sent home with script to complete total of 10 days of steroids. Off oxygen for more than 24 hours at time of discharge with improvement in shortness of breath. She did have an elevation in liver enzymes, likely 2/2 to infectious process. This improved during admission. AKI on CKD, so lisinopril was held. No need to nephrology consult at this time. Imaging did find a mass of the upper pole of the right kidney. Patient would benefit from follow up MRI outpatient.   While admitted, the patient was stable and clinically improved. They were medically stable at time of discharge, and their hospital problems are detailed below.   Acute hypoxic respiratory failure, resolved COVID-19 pneumonia Patient was hypoxic to lowmid 80s on arrival to ED on room air CXR on admission notable for minimal bibasilar opacities with cardiomegaly and a probable hiatal hernia Blood cultures NGTD Urine strep negative Urine Legionella negative CRP, ferritin WNL SORA Decadron 6 mg IV daily, transition to PO dexamethasone to complete 10 day course Stop Remdesivir 100 mg IV on discharge ID consulted, appreciate recs Bronchodilators and antipyretics as needed Maintain on enhanced droplet precautions Supportive care   Transaminitis, improving Suspect transaminitis likely secondary to acute viral process AST: ALT of 67: 54 ALP of 117 and T. bili of 0.4 Hold home Statin Monitor   AKI on CKD, stable Baseline GFR appears to be between 3040; currently at 26 BNP 1952, does not appear to be volume overloaded Weight stable (232 lbs baseline) Hold home Lasix 20 mg p.o. daily in interim Avoid nephrotoxic agents as able Renally dose medications Monitor renal function If fails to improve consider obtaining urine electrolytes, renal ultrasound and nephrology consult   Right kidney incidentaloma CT abdomen pelvis without contrast notable for complex low-attenuation mass of the upper pole of the right kidney, question a complex cyst versus solid mass Consider pre and postcontrast MRI of the kidneys outpatient   HTN Not noted to be on home oral antihypertensives As needed hydralazine Monitor BP   HLD Continue Zetia Hold home statin in setting of transaminitis   DM2 Hold home oral hypoglycemic agents Lantus and Humalog SSI POCT glucose
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Malaise, Myalgia, Renal mass, Renal neoplasm, SARS-CoV-2 test positive
Clinical narrative: Patient is a 72 y.o. female patient of DO with history of HTN, CKD, DM 2, GERD, diabetic neuropathy, HLD, CHF (unknown LVEF) who presented to Hospital with generalized fatigue, malaise, myalgias and exertional shortness of breath. She was found to be COVID positive. Placed on oxygen, which was weaned during admission. She was also treated with Remdesivir and steroids. Remdesivir stopped at discharge, but patient sent home with script to complete total of 10 days of steroids. Off oxygen for more than 24 hours at time of discharge with improvement in shortness of breath. She did have an elevation in liver enzymes, likely 2/2 to infectious process. This improved during admission. AKI on CKD, so lisinopril was held. No need to nephrology consult at this time. Imaging did find a mass of the upper pole of the right kidney. Patient would benefit from follow up MRI outpatient.   While admitted, the patient was stable and clinically improved. They were medically stable at time of discharge, and their hospital problems are detailed below.   Acute hypoxic respiratory failure, resolved COVID-19 pneumonia Patient was hypoxic to lowmid 80s on arrival to ED on room air CXR on admission notable for minimal bibasilar opacities with cardiomegaly and a probable hiatal hernia Blood cultures NGTD Urine strep negative Urine Legionella negative CRP, ferritin WNL SORA Decadron 6 mg IV daily, transition to PO dexamethasone to complete 10 day course Stop Remdesivir 100 mg IV on discharge ID consulted, appreciate recs Bronchodilators and antipyretics as needed Maintain on enhanced droplet precautions Supportive care   Transaminitis, improving Suspect transaminitis likely secondary to acute viral process AST: ALT of 67: 54 ALP of 117 and T. bili of 0.4 Hold home Statin Monitor   AKI on CKD, stable Baseline GFR appears to be between 3040; currently at 26 BNP 1952, does not appear to be volume overloaded Weight stable (232 lbs baseline) Hold home Lasix 20 mg p.o. daily in interim Avoid nephrotoxic agents as able Renally dose medications Monitor renal function If fails to improve consider obtaining urine electrolytes, renal ultrasound and nephrology consult   Right kidney incidentaloma CT abdomen pelvis without contrast notable for complex low-attenuation mass of the upper pole of the right kidney, question a complex cyst versus solid mass Consider pre and postcontrast MRI of the kidneys outpatient   HTN Not noted to be on home oral antihypertensives As needed hydralazine Monitor BP   HLD Continue Zetia Hold home statin in setting of transaminitis   DM2 Hold home oral hypoglycemic agents Lantus and Humalog SSI POCT glucose
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Serum ferritin normal, Streptococcus test negative, Viral infection
Clinical narrative: Patient is a 72 y.o. female patient of DO with history of HTN, CKD, DM 2, GERD, diabetic neuropathy, HLD, CHF (unknown LVEF) who presented to Hospital with generalized fatigue, malaise, myalgias and exertional shortness of breath. She was found to be COVID positive. Placed on oxygen, which was weaned during admission. She was also treated with Remdesivir and steroids. Remdesivir stopped at discharge, but patient sent home with script to complete total of 10 days of steroids. Off oxygen for more than 24 hours at time of discharge with improvement in shortness of breath. She did have an elevation in liver enzymes, likely 2/2 to infectious process. This improved during admission. AKI on CKD, so lisinopril was held. No need to nephrology consult at this time. Imaging did find a mass of the upper pole of the right kidney. Patient would benefit from follow up MRI outpatient.   While admitted, the patient was stable and clinically improved. They were medically stable at time of discharge, and their hospital problems are detailed below.   Acute hypoxic respiratory failure, resolved COVID-19 pneumonia Patient was hypoxic to lowmid 80s on arrival to ED on room air CXR on admission notable for minimal bibasilar opacities with cardiomegaly and a probable hiatal hernia Blood cultures NGTD Urine strep negative Urine Legionella negative CRP, ferritin WNL SORA Decadron 6 mg IV daily, transition to PO dexamethasone to complete 10 day course Stop Remdesivir 100 mg IV on discharge ID consulted, appreciate recs Bronchodilators and antipyretics as needed Maintain on enhanced droplet precautions Supportive care   Transaminitis, improving Suspect transaminitis likely secondary to acute viral process AST: ALT of 67: 54 ALP of 117 and T. bili of 0.4 Hold home Statin Monitor   AKI on CKD, stable Baseline GFR appears to be between 3040; currently at 26 BNP 1952, does not appear to be volume overloaded Weight stable (232 lbs baseline) Hold home Lasix 20 mg p.o. daily in interim Avoid nephrotoxic agents as able Renally dose medications Monitor renal function If fails to improve consider obtaining urine electrolytes, renal ultrasound and nephrology consult   Right kidney incidentaloma CT abdomen pelvis without contrast notable for complex low-attenuation mass of the upper pole of the right kidney, question a complex cyst versus solid mass Consider pre and postcontrast MRI of the kidneys outpatient   HTN Not noted to be on home oral antihypertensives As needed hydralazine Monitor BP   HLD Continue Zetia Hold home statin in setting of transaminitis   DM2 Hold home oral hypoglycemic agents Lantus and Humalog SSI POCT glucose
Age: 84.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Acute sinusitis, Agitation, Asthenia, Blood creatinine increased
Clinical narrative: Patient is a 86 y.o. female patient of MD pmh copd with chronic respiratory failure, ckd4, aortic stenosis, htn, who presents to ED from the SNF with cough and confusion for the past 3 days   Acute metabolic encephalopathy  Acute on chronic respiratory failure with hypoxia Covid-19 pneumonia Acute left maxillary and sphenoid sinusitis Suspect OSA Diagnosed with covid-19 11/23 per report, SOB, confusion, hypoxia requiring 3L  Vaccination status: vaccinated Moderna x 2 in 2022 CT chest with new opacification of LLL with air bronchograms Oxygen requirements on admission: 3 L Current oxygen requirements: 1-2 L especially in evening Medical therapy: remdesivir and steroids, procal negative antibiotics stopped Consultants following: ID, started on remdesivir and decadron   Hypoxia and confusion are improving, but pt is not at baseline At baseline, pt does have some cognitive impairment At SNF pt also had nocturnal agitation, and hypoxia requiring 2L of O2 Pt is most likely close to SNF baseline as far as above issues Completed remdesivir, stop dexamethasone due side effects Seroquel will be added to assist w sleeping and nocturnal agitation Pt is very weak, AMPAC score 8, CM consulted for SNF Pt is medically stable to return to SNF, discussing details w CM    Acute exacerbation of copd Continue dexamethasone for now, albuterol inhaler ordered as well   Bilateral LE cellulitis, improved Chronic bilateral LE edema ATB discontinued per ID   Chronic diastolic chf Continued lasix daily   CKD stage 4 Creatinine 1.26 on arrival, baseline 1.7-1.9 This am, 1.06 cont to monitor     Essential htn Bp elevated 150's to 180's; due to dexamethasone Continue nifedipine and lasix, prn hydralazine   History of stroke     History of endovascular thoracic aortic aneurysm repair 2015 History of right external iliac stent History of right femoral endarterectomy  Tobacco abuse Continued asa, statin, nicoderm
Age: 84.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, COVID-19 pneumonia, Cellulitis, Chronic obstructive pulmonary disease, Computerised tomogram thorax abnormal
Clinical narrative: Patient is a 86 y.o. female patient of MD pmh copd with chronic respiratory failure, ckd4, aortic stenosis, htn, who presents to ED from the SNF with cough and confusion for the past 3 days   Acute metabolic encephalopathy  Acute on chronic respiratory failure with hypoxia Covid-19 pneumonia Acute left maxillary and sphenoid sinusitis Suspect OSA Diagnosed with covid-19 11/23 per report, SOB, confusion, hypoxia requiring 3L  Vaccination status: vaccinated Moderna x 2 in 2022 CT chest with new opacification of LLL with air bronchograms Oxygen requirements on admission: 3 L Current oxygen requirements: 1-2 L especially in evening Medical therapy: remdesivir and steroids, procal negative antibiotics stopped Consultants following: ID, started on remdesivir and decadron   Hypoxia and confusion are improving, but pt is not at baseline At baseline, pt does have some cognitive impairment At SNF pt also had nocturnal agitation, and hypoxia requiring 2L of O2 Pt is most likely close to SNF baseline as far as above issues Completed remdesivir, stop dexamethasone due side effects Seroquel will be added to assist w sleeping and nocturnal agitation Pt is very weak, AMPAC score 8, CM consulted for SNF Pt is medically stable to return to SNF, discussing details w CM    Acute exacerbation of copd Continue dexamethasone for now, albuterol inhaler ordered as well   Bilateral LE cellulitis, improved Chronic bilateral LE edema ATB discontinued per ID   Chronic diastolic chf Continued lasix daily   CKD stage 4 Creatinine 1.26 on arrival, baseline 1.7-1.9 This am, 1.06 cont to monitor     Essential htn Bp elevated 150's to 180's; due to dexamethasone Continue nifedipine and lasix, prn hydralazine   History of stroke     History of endovascular thoracic aortic aneurysm repair 2015 History of right external iliac stent History of right femoral endarterectomy  Tobacco abuse Continued asa, statin, nicoderm
Age: 84.0
Sex: F
Vaccine: COVID19
Symptoms: Condition aggravated, Confusional state, Cough, Dyspnoea, Hypoxia
Clinical narrative: Patient is a 86 y.o. female patient of MD pmh copd with chronic respiratory failure, ckd4, aortic stenosis, htn, who presents to ED from the SNF with cough and confusion for the past 3 days   Acute metabolic encephalopathy  Acute on chronic respiratory failure with hypoxia Covid-19 pneumonia Acute left maxillary and sphenoid sinusitis Suspect OSA Diagnosed with covid-19 11/23 per report, SOB, confusion, hypoxia requiring 3L  Vaccination status: vaccinated Moderna x 2 in 2022 CT chest with new opacification of LLL with air bronchograms Oxygen requirements on admission: 3 L Current oxygen requirements: 1-2 L especially in evening Medical therapy: remdesivir and steroids, procal negative antibiotics stopped Consultants following: ID, started on remdesivir and decadron   Hypoxia and confusion are improving, but pt is not at baseline At baseline, pt does have some cognitive impairment At SNF pt also had nocturnal agitation, and hypoxia requiring 2L of O2 Pt is most likely close to SNF baseline as far as above issues Completed remdesivir, stop dexamethasone due side effects Seroquel will be added to assist w sleeping and nocturnal agitation Pt is very weak, AMPAC score 8, CM consulted for SNF Pt is medically stable to return to SNF, discussing details w CM    Acute exacerbation of copd Continue dexamethasone for now, albuterol inhaler ordered as well   Bilateral LE cellulitis, improved Chronic bilateral LE edema ATB discontinued per ID   Chronic diastolic chf Continued lasix daily   CKD stage 4 Creatinine 1.26 on arrival, baseline 1.7-1.9 This am, 1.06 cont to monitor     Essential htn Bp elevated 150's to 180's; due to dexamethasone Continue nifedipine and lasix, prn hydralazine   History of stroke     History of endovascular thoracic aortic aneurysm repair 2015 History of right external iliac stent History of right femoral endarterectomy  Tobacco abuse Continued asa, statin, nicoderm
Age: 84.0
Sex: F
Vaccine: COVID19
Symptoms: Lung opacity, Metabolic encephalopathy, Obstructive sleep apnoea syndrome, Oedema peripheral, Procalcitonin normal
Clinical narrative: Patient is a 86 y.o. female patient of MD pmh copd with chronic respiratory failure, ckd4, aortic stenosis, htn, who presents to ED from the SNF with cough and confusion for the past 3 days   Acute metabolic encephalopathy  Acute on chronic respiratory failure with hypoxia Covid-19 pneumonia Acute left maxillary and sphenoid sinusitis Suspect OSA Diagnosed with covid-19 11/23 per report, SOB, confusion, hypoxia requiring 3L  Vaccination status: vaccinated Moderna x 2 in 2022 CT chest with new opacification of LLL with air bronchograms Oxygen requirements on admission: 3 L Current oxygen requirements: 1-2 L especially in evening Medical therapy: remdesivir and steroids, procal negative antibiotics stopped Consultants following: ID, started on remdesivir and decadron   Hypoxia and confusion are improving, but pt is not at baseline At baseline, pt does have some cognitive impairment At SNF pt also had nocturnal agitation, and hypoxia requiring 2L of O2 Pt is most likely close to SNF baseline as far as above issues Completed remdesivir, stop dexamethasone due side effects Seroquel will be added to assist w sleeping and nocturnal agitation Pt is very weak, AMPAC score 8, CM consulted for SNF Pt is medically stable to return to SNF, discussing details w CM    Acute exacerbation of copd Continue dexamethasone for now, albuterol inhaler ordered as well   Bilateral LE cellulitis, improved Chronic bilateral LE edema ATB discontinued per ID   Chronic diastolic chf Continued lasix daily   CKD stage 4 Creatinine 1.26 on arrival, baseline 1.7-1.9 This am, 1.06 cont to monitor     Essential htn Bp elevated 150's to 180's; due to dexamethasone Continue nifedipine and lasix, prn hydralazine   History of stroke     History of endovascular thoracic aortic aneurysm repair 2015 History of right external iliac stent History of right femoral endarterectomy  Tobacco abuse Continued asa, statin, nicoderm
Age: 26.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal pain upper, Asthenia, Blood test, Cardiac monitoring, Chest X-ray
Clinical narrative: Chest pain, heart palpitations, arm numbness, difficulty breathing, dizziness, insomnia, tachycardia, neuropathy, headaches, stomach pain, indigestion. Debilitating to the point that I had to quit my job and move home.
Age: 26.0
Sex: F
Vaccine: COVID19
Symptoms: Chest pain, Computerised tomogram abdomen, Dizziness, Dyspepsia, Dyspnoea
Clinical narrative: Chest pain, heart palpitations, arm numbness, difficulty breathing, dizziness, insomnia, tachycardia, neuropathy, headaches, stomach pain, indigestion. Debilitating to the point that I had to quit my job and move home.
Age: 26.0
Sex: F
Vaccine: COVID19
Symptoms: Echocardiogram, Electrocardiogram, Hypoaesthesia, Impaired work ability, Insomnia
Clinical narrative: Chest pain, heart palpitations, arm numbness, difficulty breathing, dizziness, insomnia, tachycardia, neuropathy, headaches, stomach pain, indigestion. Debilitating to the point that I had to quit my job and move home.
Age: 26.0
Sex: F
Vaccine: COVID19
Symptoms: Laboratory test, Neuropathy peripheral, Palpitations, Pulmonary function test, Tachycardia
Clinical narrative: Chest pain, heart palpitations, arm numbness, difficulty breathing, dizziness, insomnia, tachycardia, neuropathy, headaches, stomach pain, indigestion. Debilitating to the point that I had to quit my job and move home.
Age: 26.0
Sex: F
Vaccine: COVID19
Symptoms: Troponin, Ultrasound abdomen
Clinical narrative: Chest pain, heart palpitations, arm numbness, difficulty breathing, dizziness, insomnia, tachycardia, neuropathy, headaches, stomach pain, indigestion. Debilitating to the point that I had to quit my job and move home.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Asthenia, COVID-19, Cough
Clinical narrative: Death Summary:  Patient is a 67 year old female with hx of recent VTE s/p thrombectomy on warfarin, hypothyroidism asthma, HTN, polymyalgia rheumatica, presented on 11/28/2023 for weakness and nonproductive cough, found to be COVID-19 positive. Pt found to have shock, requiring transfer to ICU. During ICU intake pt went into PEA arrest. Time of death was called on 11/28/2023 at 2134.    PEA arrest Acute hypoxemic respiratory failure COVID19 Infection Shock AKI Hyperkalemia Lactic acidosis Sepsis Hx of submassive pulmonary embolism s/p mechanical thrombectomy Chronic RV dysfunction Class III obesity
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Death, Hyperkalaemia, Intensive care, Lactic acidosis, Obesity
Clinical narrative: Death Summary:  Patient is a 67 year old female with hx of recent VTE s/p thrombectomy on warfarin, hypothyroidism asthma, HTN, polymyalgia rheumatica, presented on 11/28/2023 for weakness and nonproductive cough, found to be COVID-19 positive. Pt found to have shock, requiring transfer to ICU. During ICU intake pt went into PEA arrest. Time of death was called on 11/28/2023 at 2134.    PEA arrest Acute hypoxemic respiratory failure COVID19 Infection Shock AKI Hyperkalemia Lactic acidosis Sepsis Hx of submassive pulmonary embolism s/p mechanical thrombectomy Chronic RV dysfunction Class III obesity
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Pulseless electrical activity, Right ventricular dysfunction, SARS-CoV-2 test positive, Sepsis, Shock
Clinical narrative: Death Summary:  Patient is a 67 year old female with hx of recent VTE s/p thrombectomy on warfarin, hypothyroidism asthma, HTN, polymyalgia rheumatica, presented on 11/28/2023 for weakness and nonproductive cough, found to be COVID-19 positive. Pt found to have shock, requiring transfer to ICU. During ICU intake pt went into PEA arrest. Time of death was called on 11/28/2023 at 2134.    PEA arrest Acute hypoxemic respiratory failure COVID19 Infection Shock AKI Hyperkalemia Lactic acidosis Sepsis Hx of submassive pulmonary embolism s/p mechanical thrombectomy Chronic RV dysfunction Class III obesity
Age: 74.0
Sex: M
Vaccine: COVID19-2
Symptoms: Dizziness, Gait disturbance, Nausea, Vertigo
Clinical narrative: 13 day following the vaccine, extreme vertigo dizziness. Early morning nausea and inability to walk steadily or see straight.
Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Computerised tomogram head normal, Computerised tomogram thorax abnormal, Cough
Clinical narrative: Patient is a 67 y.o. male patient of MD with history of diabetes mellitus, CAD, dyslipidemia, hypertension, alcohol use, presented to Hospital with cough and congestion.  On 11/25 respiratory status decompensated and patient was transferred to ICU.   Acute hypoxic respiratory failure Lactic acidosis COVID-19 pneumonia Possible sepsis Elevated D-dimer Elevated D-dimer 586, troponin 0.09 EKG showed sinus tachycardia with HR 106, left axis deviation, possible RBBB, no significant ST or T wave abnormalities Initially patient was on 2 L however on 11/25, became short of breath and required increasing O2, and was transferred to ICU CT chest 11/25 shows multifocal reticulonodular infiltrates that are progressed On room air S/p Decadron, remdesivir and  tocilizumab per ID Antibiotics were discontinued Continue wean O2 as tolerated   Elevated troponin, possible NSTEMI In setting of worsening respiratory status Troponin has peaked Cardiology following Continue aspirin, statin, diltiazem     Acute metabolic encephalopathy Head CT negative for acute abnormality Possibly due to above in setting of infection and respiratory failure, and possible increased use of home opioids that were found in his room off Precedex   Dyslipidemia  Continue statin   hypertension Currently on losartan, Cardizem
Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea, Electrocardiogram abnormal, Fibrin D dimer increased, Intensive care, Lactic acidosis
Clinical narrative: Patient is a 67 y.o. male patient of MD with history of diabetes mellitus, CAD, dyslipidemia, hypertension, alcohol use, presented to Hospital with cough and congestion.  On 11/25 respiratory status decompensated and patient was transferred to ICU.   Acute hypoxic respiratory failure Lactic acidosis COVID-19 pneumonia Possible sepsis Elevated D-dimer Elevated D-dimer 586, troponin 0.09 EKG showed sinus tachycardia with HR 106, left axis deviation, possible RBBB, no significant ST or T wave abnormalities Initially patient was on 2 L however on 11/25, became short of breath and required increasing O2, and was transferred to ICU CT chest 11/25 shows multifocal reticulonodular infiltrates that are progressed On room air S/p Decadron, remdesivir and  tocilizumab per ID Antibiotics were discontinued Continue wean O2 as tolerated   Elevated troponin, possible NSTEMI In setting of worsening respiratory status Troponin has peaked Cardiology following Continue aspirin, statin, diltiazem     Acute metabolic encephalopathy Head CT negative for acute abnormality Possibly due to above in setting of infection and respiratory failure, and possible increased use of home opioids that were found in his room off Precedex   Dyslipidemia  Continue statin   hypertension Currently on losartan, Cardizem
Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Lung infiltration, Metabolic encephalopathy, QRS axis abnormal, Respiratory distress, Respiratory tract congestion
Clinical narrative: Patient is a 67 y.o. male patient of MD with history of diabetes mellitus, CAD, dyslipidemia, hypertension, alcohol use, presented to Hospital with cough and congestion.  On 11/25 respiratory status decompensated and patient was transferred to ICU.   Acute hypoxic respiratory failure Lactic acidosis COVID-19 pneumonia Possible sepsis Elevated D-dimer Elevated D-dimer 586, troponin 0.09 EKG showed sinus tachycardia with HR 106, left axis deviation, possible RBBB, no significant ST or T wave abnormalities Initially patient was on 2 L however on 11/25, became short of breath and required increasing O2, and was transferred to ICU CT chest 11/25 shows multifocal reticulonodular infiltrates that are progressed On room air S/p Decadron, remdesivir and  tocilizumab per ID Antibiotics were discontinued Continue wean O2 as tolerated   Elevated troponin, possible NSTEMI In setting of worsening respiratory status Troponin has peaked Cardiology following Continue aspirin, statin, diltiazem     Acute metabolic encephalopathy Head CT negative for acute abnormality Possibly due to above in setting of infection and respiratory failure, and possible increased use of home opioids that were found in his room off Precedex   Dyslipidemia  Continue statin   hypertension Currently on losartan, Cardizem
Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Sinus tachycardia, Troponin increased
Clinical narrative: Patient is a 67 y.o. male patient of MD with history of diabetes mellitus, CAD, dyslipidemia, hypertension, alcohol use, presented to Hospital with cough and congestion.  On 11/25 respiratory status decompensated and patient was transferred to ICU.   Acute hypoxic respiratory failure Lactic acidosis COVID-19 pneumonia Possible sepsis Elevated D-dimer Elevated D-dimer 586, troponin 0.09 EKG showed sinus tachycardia with HR 106, left axis deviation, possible RBBB, no significant ST or T wave abnormalities Initially patient was on 2 L however on 11/25, became short of breath and required increasing O2, and was transferred to ICU CT chest 11/25 shows multifocal reticulonodular infiltrates that are progressed On room air S/p Decadron, remdesivir and  tocilizumab per ID Antibiotics were discontinued Continue wean O2 as tolerated   Elevated troponin, possible NSTEMI In setting of worsening respiratory status Troponin has peaked Cardiology following Continue aspirin, statin, diltiazem     Acute metabolic encephalopathy Head CT negative for acute abnormality Possibly due to above in setting of infection and respiratory failure, and possible increased use of home opioids that were found in his room off Precedex   Dyslipidemia  Continue statin   hypertension Currently on losartan, Cardizem
Age: 0.33
Sex: M
Vaccine: DTAP, HIBV, RV1
Symptoms: Discomfort, Flatulence, Vomiting projectile
Clinical narrative: My baby had his vaccines done on July 19th and then started having projectile vomit for 1-2 days after the vaccines. It lasted about 10 days. I was concerned and took him in  on July 26th. After the 10 days, it finally went away l, but he was really gassy and uncomfortable.