chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Depressed level of consciousness, Dyspnoea, Essential hypertension, Hyponatraemia, Hypothyroidism
Clinical narrative: 73-year-old male past medical history of CAD, A-fib, hypertension, short-term memory loss, nursing home resident presents to the ER due to shortness of breath.  Patient states that has been more short of breath today.  He has also been less alert than baseline.  He was difficult to arouse this morning at the nursing facility.  He was unable to take his medications.  He was sent to the ER for evaluation.  Patient tested positive for COVID 2 days ago was started on molnupiravir.  No reported chest pain, focal weakness, headache.  No reported abdominal pain   Clinical Summary Patient was admitted to hospital for management of acute hypoxic respiratory failure in the setting of COVID-19 infection.  He was placed on Decadron and remdesivir.  Initially he was kept on empiric antibiotics in the case of superimposed bacterial infection as CT scan did show atelectasis versus infiltrate in the lower lobes.  His oxygenation was continually monitored.  4/5 he was continued on 3 L nasal cannula.  Procalcitonin was checked and was negative so antibiotics were de-escalated.  On 4/6 the patient's oxygenation had significantly improved and he was doing well on room air.  He did develop acute onset nausea and vomiting that was not relieved with Compazine.  KUB was obtained and showed severe gaseous distention of the stomach.  CT abdomen and pelvis was done to rule out small bowel obstruction and no obstruction was seen.  4/7 his nausea and vomiting had resolved and he was tolerating a regular diet.  His mentation had improved to baseline.  Patient was stable for discharge back to skilled nursing facility and was transferred back to facility on 4/7.   Discharge diagnosis COVID 19 infection Acute hypoxic respiratory failure -resolved  Nausea and vomiting - resolved  Metabolic encephalopathy - resolved  Hyponatremia -r esolved  Paroxysmal atrial fibrillation 1st degree AVB Chronic HFpEF Essential hypertension Hypothyroidism Morbid obesity BMI 49.3
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Lung infiltration, Mental status changes, Metabolic encephalopathy, Nausea, Obesity
Clinical narrative: 73-year-old male past medical history of CAD, A-fib, hypertension, short-term memory loss, nursing home resident presents to the ER due to shortness of breath.  Patient states that has been more short of breath today.  He has also been less alert than baseline.  He was difficult to arouse this morning at the nursing facility.  He was unable to take his medications.  He was sent to the ER for evaluation.  Patient tested positive for COVID 2 days ago was started on molnupiravir.  No reported chest pain, focal weakness, headache.  No reported abdominal pain   Clinical Summary Patient was admitted to hospital for management of acute hypoxic respiratory failure in the setting of COVID-19 infection.  He was placed on Decadron and remdesivir.  Initially he was kept on empiric antibiotics in the case of superimposed bacterial infection as CT scan did show atelectasis versus infiltrate in the lower lobes.  His oxygenation was continually monitored.  4/5 he was continued on 3 L nasal cannula.  Procalcitonin was checked and was negative so antibiotics were de-escalated.  On 4/6 the patient's oxygenation had significantly improved and he was doing well on room air.  He did develop acute onset nausea and vomiting that was not relieved with Compazine.  KUB was obtained and showed severe gaseous distention of the stomach.  CT abdomen and pelvis was done to rule out small bowel obstruction and no obstruction was seen.  4/7 his nausea and vomiting had resolved and he was tolerating a regular diet.  His mentation had improved to baseline.  Patient was stable for discharge back to skilled nursing facility and was transferred back to facility on 4/7.   Discharge diagnosis COVID 19 infection Acute hypoxic respiratory failure -resolved  Nausea and vomiting - resolved  Metabolic encephalopathy - resolved  Hyponatremia -r esolved  Paroxysmal atrial fibrillation 1st degree AVB Chronic HFpEF Essential hypertension Hypothyroidism Morbid obesity BMI 49.3
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Procalcitonin normal, SARS-CoV-2 test positive, Therapy interrupted, Urinary tract imaging abnormal, Vomiting
Clinical narrative: 73-year-old male past medical history of CAD, A-fib, hypertension, short-term memory loss, nursing home resident presents to the ER due to shortness of breath.  Patient states that has been more short of breath today.  He has also been less alert than baseline.  He was difficult to arouse this morning at the nursing facility.  He was unable to take his medications.  He was sent to the ER for evaluation.  Patient tested positive for COVID 2 days ago was started on molnupiravir.  No reported chest pain, focal weakness, headache.  No reported abdominal pain   Clinical Summary Patient was admitted to hospital for management of acute hypoxic respiratory failure in the setting of COVID-19 infection.  He was placed on Decadron and remdesivir.  Initially he was kept on empiric antibiotics in the case of superimposed bacterial infection as CT scan did show atelectasis versus infiltrate in the lower lobes.  His oxygenation was continually monitored.  4/5 he was continued on 3 L nasal cannula.  Procalcitonin was checked and was negative so antibiotics were de-escalated.  On 4/6 the patient's oxygenation had significantly improved and he was doing well on room air.  He did develop acute onset nausea and vomiting that was not relieved with Compazine.  KUB was obtained and showed severe gaseous distention of the stomach.  CT abdomen and pelvis was done to rule out small bowel obstruction and no obstruction was seen.  4/7 his nausea and vomiting had resolved and he was tolerating a regular diet.  His mentation had improved to baseline.  Patient was stable for discharge back to skilled nursing facility and was transferred back to facility on 4/7.   Discharge diagnosis COVID 19 infection Acute hypoxic respiratory failure -resolved  Nausea and vomiting - resolved  Metabolic encephalopathy - resolved  Hyponatremia -r esolved  Paroxysmal atrial fibrillation 1st degree AVB Chronic HFpEF Essential hypertension Hypothyroidism Morbid obesity BMI 49.3
Age: 37.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Anaemia, Coagulopathy
Clinical narrative: COAGULOPATHY, UNSPECIFIED TYPE 3/28/2023 ANEMIA ACUTE RESPIRATORY FAILURE 3/28/2023 ANEMIA
Age: 0.58
Sex: M
Vaccine: COVID19-2
Symptoms: No adverse event, Underdose
Clinical narrative: Dose 0.2ml/10mcg administered. Based on vaccination status, 0.25ml/25mcg is recommended. No adverse effect.
Age: 58.0
Sex: M
Vaccine: COVID19-2
Symptoms: Arthralgia, Injection site pain, Magnetic resonance imaging normal, Motor dysfunction, Sensory disturbance
Clinical narrative: chronic left shoulder pain with motor weakness. Feels like a grinding sensation at shoulder
Age: 58.0
Sex: M
Vaccine: COVID19-2
Symptoms: X-ray limb normal
Clinical narrative: chronic left shoulder pain with motor weakness. Feels like a grinding sensation at shoulder
Age: 1.17
Sex: F
Vaccine: DTAP, HIBV, PNC13
Symptoms: Pyrexia, Rash, Vomiting
Clinical narrative: Patient got a fever the following night and 6 days later got a rash, with some vomiting.
Age: 90.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Respiratory failure
Clinical narrative: ACUTE ON CHRONIC HYPOXEMIC RESPIRATORY FAILURE RESPIRATORY FAILURE, UNSPECIFIED ACUITY
Age: 43.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, Computerised tomogram, Echocardiogram, Embolic stroke, Intracardiac thrombus
Clinical narrative: EMBOLIC STROKE, CLOT IN THE HEART
Age: 43.0
Sex: F
Vaccine: COVID19-2
Symptoms: Magnetic resonance imaging
Clinical narrative: EMBOLIC STROKE, CLOT IN THE HEART
Age: 60.0
Sex: F
Vaccine: COVID19-2
Symptoms: Injection site pain, Muscular weakness
Clinical narrative: left shoulder pain at injection site, left arm weakness Ongoing since vaccination.
Age: 73.0
Sex: F
Vaccine: COVID19-2
Symptoms: Chronic respiratory failure, Respiratory failure
Clinical narrative: CHRONIC HYPERCAPNIC RESPIRATORY FAILURE
Age: 75.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Hypoxia
Clinical narrative: ACUTE HYPOXEMIC RESPIRATORY FAILURE HYPOXIA
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Atrial fibrillation, Blood creatinine, Blood culture negative
Clinical narrative: Patient is a 83 y.o. female patient with history of  Dementia, hypertension, hypothyroidism, atrial fibrillation, bradycardia status post pacemaker, systolic CHF presented to Grady Memorial Hospital with altered mental status.   Covid-19 Virus Infection Date of onset of symptoms: 4/10/2023 Symptoms present on admission: AMS, SOB Date of covid positive test: 04/18/23 Vaccination status: vaccinated Imaging: Fibrotic scaring with R pulmonary nodule Current O2 requirement 6 L>4L (baseline 3 to 4 L of oxygen). Medical therapy: Received 4 doses of IV remdesivir and dexamethasone  CRP 11.5; ferritin 93.  Did not continue steroids at discharge per pulmonology recommendations Pulmonology followed in the hospital and signed off. Anticipated special isolation end date: 4/28/23   Acute on Chronic Respiratory Failure with Hypoxia Etiology: Secondary to COVID.  Chronic respiratory failure due to poor pulmonary reserve from body habitus. Baseline oxygen 3-4 L NC Procalcitonin low at 0.11.  Blood culture x2-NGTD.  No need of ATB. Initially required up to 6L NC, but was able to wean down to 3 to 4 L of oxygen    Metabolic Encephalopathy improved Secondary to COVID and hypoxia Improved in ED after oxygen administration Mental status closer to baseline with some waxing and waning Consulted PT/OT.  Recommended SNF. DC to SNF for continued therapy   Lactic Acidosis Hypovolemia Admit LA 7.4> 2.1 Likely secondary to poor PO intake and diuretic use LA improved with IV fluids   Acute Kidney Injury, resolved Baseline Cr: 0.9. Admit Cr: 1.51> 1.4> 1.16>0.78 Likely prerenal from poor oral intake and use of Lasix.   Cr improved with IV fluids.  Avoid nephrotoxic medications   Chronic systolic CHF Echo from 2021 with EF 35+/- 5%.  Pulmonary hypertension RVSP 55 mmHg. BNP elevated at 10 K on admission. Echo with EF 55+/- 5%, severe tricuspid valve regurgitation, RVSP 74 mmHg. Continue home Lasix 20 mg daily Daily weights and strict I's/O Persistent Atrial fibrillation History of bradycardia status post pacemaker Patient follows with cardiologist and recently had her pacemaker interrogated and PRA reports no abnormalities noted Continue home: Toprol-XL, Xarelto   Hypothyroidism ESS from 3/29/2023--8.05; T4 normal at 1.2 Home dose of Synthroid was recently increased to 125 mcg daily. Recommend repeating TSH and free T4 in 6-8 weeks   Hypotension Patient is having some hypotension and was placed on midodrine by her cardiologist due to this Continue midodrine therapy BP stable   Dementia Without behavioral disturbances at this time Continue home Aricept   Pulmonary Nodule Seen on CT scan According to pulmonology, considering her age and comorbidities she does not need repeat outpatient imaging
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Blood lactic acid, Brain natriuretic peptide increased, C-reactive protein increased, COVID-19, Cardiac failure congestive
Clinical narrative: Patient is a 83 y.o. female patient with history of  Dementia, hypertension, hypothyroidism, atrial fibrillation, bradycardia status post pacemaker, systolic CHF presented to Grady Memorial Hospital with altered mental status.   Covid-19 Virus Infection Date of onset of symptoms: 4/10/2023 Symptoms present on admission: AMS, SOB Date of covid positive test: 04/18/23 Vaccination status: vaccinated Imaging: Fibrotic scaring with R pulmonary nodule Current O2 requirement 6 L>4L (baseline 3 to 4 L of oxygen). Medical therapy: Received 4 doses of IV remdesivir and dexamethasone  CRP 11.5; ferritin 93.  Did not continue steroids at discharge per pulmonology recommendations Pulmonology followed in the hospital and signed off. Anticipated special isolation end date: 4/28/23   Acute on Chronic Respiratory Failure with Hypoxia Etiology: Secondary to COVID.  Chronic respiratory failure due to poor pulmonary reserve from body habitus. Baseline oxygen 3-4 L NC Procalcitonin low at 0.11.  Blood culture x2-NGTD.  No need of ATB. Initially required up to 6L NC, but was able to wean down to 3 to 4 L of oxygen    Metabolic Encephalopathy improved Secondary to COVID and hypoxia Improved in ED after oxygen administration Mental status closer to baseline with some waxing and waning Consulted PT/OT.  Recommended SNF. DC to SNF for continued therapy   Lactic Acidosis Hypovolemia Admit LA 7.4> 2.1 Likely secondary to poor PO intake and diuretic use LA improved with IV fluids   Acute Kidney Injury, resolved Baseline Cr: 0.9. Admit Cr: 1.51> 1.4> 1.16>0.78 Likely prerenal from poor oral intake and use of Lasix.   Cr improved with IV fluids.  Avoid nephrotoxic medications   Chronic systolic CHF Echo from 2021 with EF 35+/- 5%.  Pulmonary hypertension RVSP 55 mmHg. BNP elevated at 10 K on admission. Echo with EF 55+/- 5%, severe tricuspid valve regurgitation, RVSP 74 mmHg. Continue home Lasix 20 mg daily Daily weights and strict I's/O Persistent Atrial fibrillation History of bradycardia status post pacemaker Patient follows with cardiologist and recently had her pacemaker interrogated and PRA reports no abnormalities noted Continue home: Toprol-XL, Xarelto   Hypothyroidism ESS from 3/29/2023--8.05; T4 normal at 1.2 Home dose of Synthroid was recently increased to 125 mcg daily. Recommend repeating TSH and free T4 in 6-8 weeks   Hypotension Patient is having some hypotension and was placed on midodrine by her cardiologist due to this Continue midodrine therapy BP stable   Dementia Without behavioral disturbances at this time Continue home Aricept   Pulmonary Nodule Seen on CT scan According to pulmonology, considering her age and comorbidities she does not need repeat outpatient imaging
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Cardiac pacemaker evaluation, Chronic left ventricular failure, Chronic respiratory failure, Computerised tomogram thorax abnormal, Condition aggravated
Clinical narrative: Patient is a 83 y.o. female patient with history of  Dementia, hypertension, hypothyroidism, atrial fibrillation, bradycardia status post pacemaker, systolic CHF presented to Grady Memorial Hospital with altered mental status.   Covid-19 Virus Infection Date of onset of symptoms: 4/10/2023 Symptoms present on admission: AMS, SOB Date of covid positive test: 04/18/23 Vaccination status: vaccinated Imaging: Fibrotic scaring with R pulmonary nodule Current O2 requirement 6 L>4L (baseline 3 to 4 L of oxygen). Medical therapy: Received 4 doses of IV remdesivir and dexamethasone  CRP 11.5; ferritin 93.  Did not continue steroids at discharge per pulmonology recommendations Pulmonology followed in the hospital and signed off. Anticipated special isolation end date: 4/28/23   Acute on Chronic Respiratory Failure with Hypoxia Etiology: Secondary to COVID.  Chronic respiratory failure due to poor pulmonary reserve from body habitus. Baseline oxygen 3-4 L NC Procalcitonin low at 0.11.  Blood culture x2-NGTD.  No need of ATB. Initially required up to 6L NC, but was able to wean down to 3 to 4 L of oxygen    Metabolic Encephalopathy improved Secondary to COVID and hypoxia Improved in ED after oxygen administration Mental status closer to baseline with some waxing and waning Consulted PT/OT.  Recommended SNF. DC to SNF for continued therapy   Lactic Acidosis Hypovolemia Admit LA 7.4> 2.1 Likely secondary to poor PO intake and diuretic use LA improved with IV fluids   Acute Kidney Injury, resolved Baseline Cr: 0.9. Admit Cr: 1.51> 1.4> 1.16>0.78 Likely prerenal from poor oral intake and use of Lasix.   Cr improved with IV fluids.  Avoid nephrotoxic medications   Chronic systolic CHF Echo from 2021 with EF 35+/- 5%.  Pulmonary hypertension RVSP 55 mmHg. BNP elevated at 10 K on admission. Echo with EF 55+/- 5%, severe tricuspid valve regurgitation, RVSP 74 mmHg. Continue home Lasix 20 mg daily Daily weights and strict I's/O Persistent Atrial fibrillation History of bradycardia status post pacemaker Patient follows with cardiologist and recently had her pacemaker interrogated and PRA reports no abnormalities noted Continue home: Toprol-XL, Xarelto   Hypothyroidism ESS from 3/29/2023--8.05; T4 normal at 1.2 Home dose of Synthroid was recently increased to 125 mcg daily. Recommend repeating TSH and free T4 in 6-8 weeks   Hypotension Patient is having some hypotension and was placed on midodrine by her cardiologist due to this Continue midodrine therapy BP stable   Dementia Without behavioral disturbances at this time Continue home Aricept   Pulmonary Nodule Seen on CT scan According to pulmonology, considering her age and comorbidities she does not need repeat outpatient imaging
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Diuretic therapy, Dyspnoea, Echocardiogram abnormal, Ejection fraction decreased, Hypophagia
Clinical narrative: Patient is a 83 y.o. female patient with history of  Dementia, hypertension, hypothyroidism, atrial fibrillation, bradycardia status post pacemaker, systolic CHF presented to Grady Memorial Hospital with altered mental status.   Covid-19 Virus Infection Date of onset of symptoms: 4/10/2023 Symptoms present on admission: AMS, SOB Date of covid positive test: 04/18/23 Vaccination status: vaccinated Imaging: Fibrotic scaring with R pulmonary nodule Current O2 requirement 6 L>4L (baseline 3 to 4 L of oxygen). Medical therapy: Received 4 doses of IV remdesivir and dexamethasone  CRP 11.5; ferritin 93.  Did not continue steroids at discharge per pulmonology recommendations Pulmonology followed in the hospital and signed off. Anticipated special isolation end date: 4/28/23   Acute on Chronic Respiratory Failure with Hypoxia Etiology: Secondary to COVID.  Chronic respiratory failure due to poor pulmonary reserve from body habitus. Baseline oxygen 3-4 L NC Procalcitonin low at 0.11.  Blood culture x2-NGTD.  No need of ATB. Initially required up to 6L NC, but was able to wean down to 3 to 4 L of oxygen    Metabolic Encephalopathy improved Secondary to COVID and hypoxia Improved in ED after oxygen administration Mental status closer to baseline with some waxing and waning Consulted PT/OT.  Recommended SNF. DC to SNF for continued therapy   Lactic Acidosis Hypovolemia Admit LA 7.4> 2.1 Likely secondary to poor PO intake and diuretic use LA improved with IV fluids   Acute Kidney Injury, resolved Baseline Cr: 0.9. Admit Cr: 1.51> 1.4> 1.16>0.78 Likely prerenal from poor oral intake and use of Lasix.   Cr improved with IV fluids.  Avoid nephrotoxic medications   Chronic systolic CHF Echo from 2021 with EF 35+/- 5%.  Pulmonary hypertension RVSP 55 mmHg. BNP elevated at 10 K on admission. Echo with EF 55+/- 5%, severe tricuspid valve regurgitation, RVSP 74 mmHg. Continue home Lasix 20 mg daily Daily weights and strict I's/O Persistent Atrial fibrillation History of bradycardia status post pacemaker Patient follows with cardiologist and recently had her pacemaker interrogated and PRA reports no abnormalities noted Continue home: Toprol-XL, Xarelto   Hypothyroidism ESS from 3/29/2023--8.05; T4 normal at 1.2 Home dose of Synthroid was recently increased to 125 mcg daily. Recommend repeating TSH and free T4 in 6-8 weeks   Hypotension Patient is having some hypotension and was placed on midodrine by her cardiologist due to this Continue midodrine therapy BP stable   Dementia Without behavioral disturbances at this time Continue home Aricept   Pulmonary Nodule Seen on CT scan According to pulmonology, considering her age and comorbidities she does not need repeat outpatient imaging
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Hypotension, Hypovolaemia, Hypoxia, Lactic acidosis, Mental status changes
Clinical narrative: Patient is a 83 y.o. female patient with history of  Dementia, hypertension, hypothyroidism, atrial fibrillation, bradycardia status post pacemaker, systolic CHF presented to Grady Memorial Hospital with altered mental status.   Covid-19 Virus Infection Date of onset of symptoms: 4/10/2023 Symptoms present on admission: AMS, SOB Date of covid positive test: 04/18/23 Vaccination status: vaccinated Imaging: Fibrotic scaring with R pulmonary nodule Current O2 requirement 6 L>4L (baseline 3 to 4 L of oxygen). Medical therapy: Received 4 doses of IV remdesivir and dexamethasone  CRP 11.5; ferritin 93.  Did not continue steroids at discharge per pulmonology recommendations Pulmonology followed in the hospital and signed off. Anticipated special isolation end date: 4/28/23   Acute on Chronic Respiratory Failure with Hypoxia Etiology: Secondary to COVID.  Chronic respiratory failure due to poor pulmonary reserve from body habitus. Baseline oxygen 3-4 L NC Procalcitonin low at 0.11.  Blood culture x2-NGTD.  No need of ATB. Initially required up to 6L NC, but was able to wean down to 3 to 4 L of oxygen    Metabolic Encephalopathy improved Secondary to COVID and hypoxia Improved in ED after oxygen administration Mental status closer to baseline with some waxing and waning Consulted PT/OT.  Recommended SNF. DC to SNF for continued therapy   Lactic Acidosis Hypovolemia Admit LA 7.4> 2.1 Likely secondary to poor PO intake and diuretic use LA improved with IV fluids   Acute Kidney Injury, resolved Baseline Cr: 0.9. Admit Cr: 1.51> 1.4> 1.16>0.78 Likely prerenal from poor oral intake and use of Lasix.   Cr improved with IV fluids.  Avoid nephrotoxic medications   Chronic systolic CHF Echo from 2021 with EF 35+/- 5%.  Pulmonary hypertension RVSP 55 mmHg. BNP elevated at 10 K on admission. Echo with EF 55+/- 5%, severe tricuspid valve regurgitation, RVSP 74 mmHg. Continue home Lasix 20 mg daily Daily weights and strict I's/O Persistent Atrial fibrillation History of bradycardia status post pacemaker Patient follows with cardiologist and recently had her pacemaker interrogated and PRA reports no abnormalities noted Continue home: Toprol-XL, Xarelto   Hypothyroidism ESS from 3/29/2023--8.05; T4 normal at 1.2 Home dose of Synthroid was recently increased to 125 mcg daily. Recommend repeating TSH and free T4 in 6-8 weeks   Hypotension Patient is having some hypotension and was placed on midodrine by her cardiologist due to this Continue midodrine therapy BP stable   Dementia Without behavioral disturbances at this time Continue home Aricept   Pulmonary Nodule Seen on CT scan According to pulmonology, considering her age and comorbidities she does not need repeat outpatient imaging
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Metabolic encephalopathy, Procalcitonin decreased, Pulmonary fibrosis, Pulmonary hypertension, Pulmonary mass
Clinical narrative: Patient is a 83 y.o. female patient with history of  Dementia, hypertension, hypothyroidism, atrial fibrillation, bradycardia status post pacemaker, systolic CHF presented to Grady Memorial Hospital with altered mental status.   Covid-19 Virus Infection Date of onset of symptoms: 4/10/2023 Symptoms present on admission: AMS, SOB Date of covid positive test: 04/18/23 Vaccination status: vaccinated Imaging: Fibrotic scaring with R pulmonary nodule Current O2 requirement 6 L>4L (baseline 3 to 4 L of oxygen). Medical therapy: Received 4 doses of IV remdesivir and dexamethasone  CRP 11.5; ferritin 93.  Did not continue steroids at discharge per pulmonology recommendations Pulmonology followed in the hospital and signed off. Anticipated special isolation end date: 4/28/23   Acute on Chronic Respiratory Failure with Hypoxia Etiology: Secondary to COVID.  Chronic respiratory failure due to poor pulmonary reserve from body habitus. Baseline oxygen 3-4 L NC Procalcitonin low at 0.11.  Blood culture x2-NGTD.  No need of ATB. Initially required up to 6L NC, but was able to wean down to 3 to 4 L of oxygen    Metabolic Encephalopathy improved Secondary to COVID and hypoxia Improved in ED after oxygen administration Mental status closer to baseline with some waxing and waning Consulted PT/OT.  Recommended SNF. DC to SNF for continued therapy   Lactic Acidosis Hypovolemia Admit LA 7.4> 2.1 Likely secondary to poor PO intake and diuretic use LA improved with IV fluids   Acute Kidney Injury, resolved Baseline Cr: 0.9. Admit Cr: 1.51> 1.4> 1.16>0.78 Likely prerenal from poor oral intake and use of Lasix.   Cr improved with IV fluids.  Avoid nephrotoxic medications   Chronic systolic CHF Echo from 2021 with EF 35+/- 5%.  Pulmonary hypertension RVSP 55 mmHg. BNP elevated at 10 K on admission. Echo with EF 55+/- 5%, severe tricuspid valve regurgitation, RVSP 74 mmHg. Continue home Lasix 20 mg daily Daily weights and strict I's/O Persistent Atrial fibrillation History of bradycardia status post pacemaker Patient follows with cardiologist and recently had her pacemaker interrogated and PRA reports no abnormalities noted Continue home: Toprol-XL, Xarelto   Hypothyroidism ESS from 3/29/2023--8.05; T4 normal at 1.2 Home dose of Synthroid was recently increased to 125 mcg daily. Recommend repeating TSH and free T4 in 6-8 weeks   Hypotension Patient is having some hypotension and was placed on midodrine by her cardiologist due to this Continue midodrine therapy BP stable   Dementia Without behavioral disturbances at this time Continue home Aricept   Pulmonary Nodule Seen on CT scan According to pulmonology, considering her age and comorbidities she does not need repeat outpatient imaging
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Respiratory failure, Right ventricular systolic pressure, SARS-CoV-2 test positive, Serum ferritin normal, Thyroxine normal
Clinical narrative: Patient is a 83 y.o. female patient with history of  Dementia, hypertension, hypothyroidism, atrial fibrillation, bradycardia status post pacemaker, systolic CHF presented to Grady Memorial Hospital with altered mental status.   Covid-19 Virus Infection Date of onset of symptoms: 4/10/2023 Symptoms present on admission: AMS, SOB Date of covid positive test: 04/18/23 Vaccination status: vaccinated Imaging: Fibrotic scaring with R pulmonary nodule Current O2 requirement 6 L>4L (baseline 3 to 4 L of oxygen). Medical therapy: Received 4 doses of IV remdesivir and dexamethasone  CRP 11.5; ferritin 93.  Did not continue steroids at discharge per pulmonology recommendations Pulmonology followed in the hospital and signed off. Anticipated special isolation end date: 4/28/23   Acute on Chronic Respiratory Failure with Hypoxia Etiology: Secondary to COVID.  Chronic respiratory failure due to poor pulmonary reserve from body habitus. Baseline oxygen 3-4 L NC Procalcitonin low at 0.11.  Blood culture x2-NGTD.  No need of ATB. Initially required up to 6L NC, but was able to wean down to 3 to 4 L of oxygen    Metabolic Encephalopathy improved Secondary to COVID and hypoxia Improved in ED after oxygen administration Mental status closer to baseline with some waxing and waning Consulted PT/OT.  Recommended SNF. DC to SNF for continued therapy   Lactic Acidosis Hypovolemia Admit LA 7.4> 2.1 Likely secondary to poor PO intake and diuretic use LA improved with IV fluids   Acute Kidney Injury, resolved Baseline Cr: 0.9. Admit Cr: 1.51> 1.4> 1.16>0.78 Likely prerenal from poor oral intake and use of Lasix.   Cr improved with IV fluids.  Avoid nephrotoxic medications   Chronic systolic CHF Echo from 2021 with EF 35+/- 5%.  Pulmonary hypertension RVSP 55 mmHg. BNP elevated at 10 K on admission. Echo with EF 55+/- 5%, severe tricuspid valve regurgitation, RVSP 74 mmHg. Continue home Lasix 20 mg daily Daily weights and strict I's/O Persistent Atrial fibrillation History of bradycardia status post pacemaker Patient follows with cardiologist and recently had her pacemaker interrogated and PRA reports no abnormalities noted Continue home: Toprol-XL, Xarelto   Hypothyroidism ESS from 3/29/2023--8.05; T4 normal at 1.2 Home dose of Synthroid was recently increased to 125 mcg daily. Recommend repeating TSH and free T4 in 6-8 weeks   Hypotension Patient is having some hypotension and was placed on midodrine by her cardiologist due to this Continue midodrine therapy BP stable   Dementia Without behavioral disturbances at this time Continue home Aricept   Pulmonary Nodule Seen on CT scan According to pulmonology, considering her age and comorbidities she does not need repeat outpatient imaging
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Tricuspid valve incompetence
Clinical narrative: Patient is a 83 y.o. female patient with history of  Dementia, hypertension, hypothyroidism, atrial fibrillation, bradycardia status post pacemaker, systolic CHF presented to Grady Memorial Hospital with altered mental status.   Covid-19 Virus Infection Date of onset of symptoms: 4/10/2023 Symptoms present on admission: AMS, SOB Date of covid positive test: 04/18/23 Vaccination status: vaccinated Imaging: Fibrotic scaring with R pulmonary nodule Current O2 requirement 6 L>4L (baseline 3 to 4 L of oxygen). Medical therapy: Received 4 doses of IV remdesivir and dexamethasone  CRP 11.5; ferritin 93.  Did not continue steroids at discharge per pulmonology recommendations Pulmonology followed in the hospital and signed off. Anticipated special isolation end date: 4/28/23   Acute on Chronic Respiratory Failure with Hypoxia Etiology: Secondary to COVID.  Chronic respiratory failure due to poor pulmonary reserve from body habitus. Baseline oxygen 3-4 L NC Procalcitonin low at 0.11.  Blood culture x2-NGTD.  No need of ATB. Initially required up to 6L NC, but was able to wean down to 3 to 4 L of oxygen    Metabolic Encephalopathy improved Secondary to COVID and hypoxia Improved in ED after oxygen administration Mental status closer to baseline with some waxing and waning Consulted PT/OT.  Recommended SNF. DC to SNF for continued therapy   Lactic Acidosis Hypovolemia Admit LA 7.4> 2.1 Likely secondary to poor PO intake and diuretic use LA improved with IV fluids   Acute Kidney Injury, resolved Baseline Cr: 0.9. Admit Cr: 1.51> 1.4> 1.16>0.78 Likely prerenal from poor oral intake and use of Lasix.   Cr improved with IV fluids.  Avoid nephrotoxic medications   Chronic systolic CHF Echo from 2021 with EF 35+/- 5%.  Pulmonary hypertension RVSP 55 mmHg. BNP elevated at 10 K on admission. Echo with EF 55+/- 5%, severe tricuspid valve regurgitation, RVSP 74 mmHg. Continue home Lasix 20 mg daily Daily weights and strict I's/O Persistent Atrial fibrillation History of bradycardia status post pacemaker Patient follows with cardiologist and recently had her pacemaker interrogated and PRA reports no abnormalities noted Continue home: Toprol-XL, Xarelto   Hypothyroidism ESS from 3/29/2023--8.05; T4 normal at 1.2 Home dose of Synthroid was recently increased to 125 mcg daily. Recommend repeating TSH and free T4 in 6-8 weeks   Hypotension Patient is having some hypotension and was placed on midodrine by her cardiologist due to this Continue midodrine therapy BP stable   Dementia Without behavioral disturbances at this time Continue home Aricept   Pulmonary Nodule Seen on CT scan According to pulmonology, considering her age and comorbidities she does not need repeat outpatient imaging
Age: 64.0
Sex: M
Vaccine: COVID19-2
Symptoms: Hypoxia, Symptom recurrence
Clinical narrative: .HYPOXEMIA 2/27/2023  &   1/27/2023  --  RECURRENCE OF HOSPITALIZATION WITH SAME SYMPTOMS
Age: 17.0
Sex: F
Vaccine: MENB
Symptoms: Blood calcium decreased, Blood chloride, Blood creatinine normal, Blood glucose normal, Blood potassium
Clinical narrative: Fainting, possible seizure, vomiting  5 hours after vaccine patient felt faint. Passed out for a few seconds, L lateral gaze, arms stiff, + shaking. No post-ictal state.  Patient was taken to to the ED.
Age: 17.0
Sex: F
Vaccine: MENB
Symptoms: Blood sodium decreased, Carbon dioxide, Dizziness, Electrocardiogram normal, Gaze palsy
Clinical narrative: Fainting, possible seizure, vomiting  5 hours after vaccine patient felt faint. Passed out for a few seconds, L lateral gaze, arms stiff, + shaking. No post-ictal state.  Patient was taken to to the ED.
Age: 17.0
Sex: F
Vaccine: MENB
Symptoms: Haemoglobin normal, Loss of consciousness, Musculoskeletal stiffness, Syncope, Tremor
Clinical narrative: Fainting, possible seizure, vomiting  5 hours after vaccine patient felt faint. Passed out for a few seconds, L lateral gaze, arms stiff, + shaking. No post-ictal state.  Patient was taken to to the ED.
Age: 17.0
Sex: F
Vaccine: MENB
Symptoms: Vomiting
Clinical narrative: Fainting, possible seizure, vomiting  5 hours after vaccine patient felt faint. Passed out for a few seconds, L lateral gaze, arms stiff, + shaking. No post-ictal state.  Patient was taken to to the ED.
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Acute sinusitis, Asthenia, Blood gases abnormal, Blood lactic acid, Blood pH increased
Clinical narrative: Clinical Summary Patient is a 80 y.o. female with a history of Alzheimer's disease, hypertension and glaucoma who presented to hospital 4/13/2023 with fever and altered mental status. Patient found to have COVID 19, labs with BMP, CBC, BMP, HFP, lipase unrevealing. LA 1.1, UA without infection. Admit VBG with pH 7.4, pCO2 and pO2 stable. CXR non-acute.  CT head with no acute intracranial findings, noted acute pansinusitis.    1. COVID 19 Infection: Presented as above. Vaccinated and boosted, denies prior COVID infections. Symptom onset 4/12/23. Admit CXR non-acute. Not requiring O2 on admit, therefore defer decadron or remdesivir. Consult to ID and started and completed course of paxlovid. Symptoms improved.  2. Sepsis: Met criteria with Temp 100.8, tachycardia on presentation. Secondary to COVID as above. CXR and UA without infection. CT head with pansinusitis. Procal negative. On Vanc/Zosyn in ED, held on further antibiotics on admit as suspect viral etiology or sepsis criteria with COVID. Given 1.5 L bolus in ED. Now dry lung strategy with COVID. Treat as discussed and monitor.   3. Acute Metabolic Encephalopathy on Chronic Dementia: Family describes 3-4 month cognitive and functional decline with history of Alzheimers dementia. Per family, prior baseline was alert and oriented with short term memory deficits. Recent baseline waxes and wanes, minimal short term memory. Family feels patient is at recent baseline on admit. Oriented to self, general location, month, year and family on admit. Continued home Remeron. Delirium precautions.  4. Oral thrush: Noted 4/15/23. Nystatin swish and spit continued. 5. Elevated Troponin: Admit Trop 19, second trop 17. Admit EKG with sinus tachycardia, no acute ischemic changes. No chest pain on admit. Suspect demand ischemia with above. No other ischemic eval planned.  6. Acute sinusitis: Diagnosed on admission. Completed Augmentin course 4/18/23. 7. Fall: Secondary to weakness at home. Unable to get off toilet and assisted to ground by family. Denied injuries or hitting head. PT/OT consulted, family interested in SNF on discharge.  8. Hypertension: Per history, continued home Cozaar with hold parameters. Monitor and titrate PRN.  9. Glaucoma: Per history, continued home eye drops.
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Chest X-ray normal, Cognitive disorder, Computerised tomogram head abnormal, Dysstasia
Clinical narrative: Clinical Summary Patient is a 80 y.o. female with a history of Alzheimer's disease, hypertension and glaucoma who presented to hospital 4/13/2023 with fever and altered mental status. Patient found to have COVID 19, labs with BMP, CBC, BMP, HFP, lipase unrevealing. LA 1.1, UA without infection. Admit VBG with pH 7.4, pCO2 and pO2 stable. CXR non-acute.  CT head with no acute intracranial findings, noted acute pansinusitis.    1. COVID 19 Infection: Presented as above. Vaccinated and boosted, denies prior COVID infections. Symptom onset 4/12/23. Admit CXR non-acute. Not requiring O2 on admit, therefore defer decadron or remdesivir. Consult to ID and started and completed course of paxlovid. Symptoms improved.  2. Sepsis: Met criteria with Temp 100.8, tachycardia on presentation. Secondary to COVID as above. CXR and UA without infection. CT head with pansinusitis. Procal negative. On Vanc/Zosyn in ED, held on further antibiotics on admit as suspect viral etiology or sepsis criteria with COVID. Given 1.5 L bolus in ED. Now dry lung strategy with COVID. Treat as discussed and monitor.   3. Acute Metabolic Encephalopathy on Chronic Dementia: Family describes 3-4 month cognitive and functional decline with history of Alzheimers dementia. Per family, prior baseline was alert and oriented with short term memory deficits. Recent baseline waxes and wanes, minimal short term memory. Family feels patient is at recent baseline on admit. Oriented to self, general location, month, year and family on admit. Continued home Remeron. Delirium precautions.  4. Oral thrush: Noted 4/15/23. Nystatin swish and spit continued. 5. Elevated Troponin: Admit Trop 19, second trop 17. Admit EKG with sinus tachycardia, no acute ischemic changes. No chest pain on admit. Suspect demand ischemia with above. No other ischemic eval planned.  6. Acute sinusitis: Diagnosed on admission. Completed Augmentin course 4/18/23. 7. Fall: Secondary to weakness at home. Unable to get off toilet and assisted to ground by family. Denied injuries or hitting head. PT/OT consulted, family interested in SNF on discharge.  8. Hypertension: Per history, continued home Cozaar with hold parameters. Monitor and titrate PRN.  9. Glaucoma: Per history, continued home eye drops.
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Electrocardiogram abnormal, Encephalopathy, Fall, Full blood count, Laboratory test
Clinical narrative: Clinical Summary Patient is a 80 y.o. female with a history of Alzheimer's disease, hypertension and glaucoma who presented to hospital 4/13/2023 with fever and altered mental status. Patient found to have COVID 19, labs with BMP, CBC, BMP, HFP, lipase unrevealing. LA 1.1, UA without infection. Admit VBG with pH 7.4, pCO2 and pO2 stable. CXR non-acute.  CT head with no acute intracranial findings, noted acute pansinusitis.    1. COVID 19 Infection: Presented as above. Vaccinated and boosted, denies prior COVID infections. Symptom onset 4/12/23. Admit CXR non-acute. Not requiring O2 on admit, therefore defer decadron or remdesivir. Consult to ID and started and completed course of paxlovid. Symptoms improved.  2. Sepsis: Met criteria with Temp 100.8, tachycardia on presentation. Secondary to COVID as above. CXR and UA without infection. CT head with pansinusitis. Procal negative. On Vanc/Zosyn in ED, held on further antibiotics on admit as suspect viral etiology or sepsis criteria with COVID. Given 1.5 L bolus in ED. Now dry lung strategy with COVID. Treat as discussed and monitor.   3. Acute Metabolic Encephalopathy on Chronic Dementia: Family describes 3-4 month cognitive and functional decline with history of Alzheimers dementia. Per family, prior baseline was alert and oriented with short term memory deficits. Recent baseline waxes and wanes, minimal short term memory. Family feels patient is at recent baseline on admit. Oriented to self, general location, month, year and family on admit. Continued home Remeron. Delirium precautions.  4. Oral thrush: Noted 4/15/23. Nystatin swish and spit continued. 5. Elevated Troponin: Admit Trop 19, second trop 17. Admit EKG with sinus tachycardia, no acute ischemic changes. No chest pain on admit. Suspect demand ischemia with above. No other ischemic eval planned.  6. Acute sinusitis: Diagnosed on admission. Completed Augmentin course 4/18/23. 7. Fall: Secondary to weakness at home. Unable to get off toilet and assisted to ground by family. Denied injuries or hitting head. PT/OT consulted, family interested in SNF on discharge.  8. Hypertension: Per history, continued home Cozaar with hold parameters. Monitor and titrate PRN.  9. Glaucoma: Per history, continued home eye drops.
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Lipase, Liver function test, Mental status changes, Metabolic encephalopathy, Metabolic function test
Clinical narrative: Clinical Summary Patient is a 80 y.o. female with a history of Alzheimer's disease, hypertension and glaucoma who presented to hospital 4/13/2023 with fever and altered mental status. Patient found to have COVID 19, labs with BMP, CBC, BMP, HFP, lipase unrevealing. LA 1.1, UA without infection. Admit VBG with pH 7.4, pCO2 and pO2 stable. CXR non-acute.  CT head with no acute intracranial findings, noted acute pansinusitis.    1. COVID 19 Infection: Presented as above. Vaccinated and boosted, denies prior COVID infections. Symptom onset 4/12/23. Admit CXR non-acute. Not requiring O2 on admit, therefore defer decadron or remdesivir. Consult to ID and started and completed course of paxlovid. Symptoms improved.  2. Sepsis: Met criteria with Temp 100.8, tachycardia on presentation. Secondary to COVID as above. CXR and UA without infection. CT head with pansinusitis. Procal negative. On Vanc/Zosyn in ED, held on further antibiotics on admit as suspect viral etiology or sepsis criteria with COVID. Given 1.5 L bolus in ED. Now dry lung strategy with COVID. Treat as discussed and monitor.   3. Acute Metabolic Encephalopathy on Chronic Dementia: Family describes 3-4 month cognitive and functional decline with history of Alzheimers dementia. Per family, prior baseline was alert and oriented with short term memory deficits. Recent baseline waxes and wanes, minimal short term memory. Family feels patient is at recent baseline on admit. Oriented to self, general location, month, year and family on admit. Continued home Remeron. Delirium precautions.  4. Oral thrush: Noted 4/15/23. Nystatin swish and spit continued. 5. Elevated Troponin: Admit Trop 19, second trop 17. Admit EKG with sinus tachycardia, no acute ischemic changes. No chest pain on admit. Suspect demand ischemia with above. No other ischemic eval planned.  6. Acute sinusitis: Diagnosed on admission. Completed Augmentin course 4/18/23. 7. Fall: Secondary to weakness at home. Unable to get off toilet and assisted to ground by family. Denied injuries or hitting head. PT/OT consulted, family interested in SNF on discharge.  8. Hypertension: Per history, continued home Cozaar with hold parameters. Monitor and titrate PRN.  9. Glaucoma: Per history, continued home eye drops.
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Mobility decreased, Myocardial ischaemia, Oral candidiasis, PCO2 normal, PO2 normal
Clinical narrative: Clinical Summary Patient is a 80 y.o. female with a history of Alzheimer's disease, hypertension and glaucoma who presented to hospital 4/13/2023 with fever and altered mental status. Patient found to have COVID 19, labs with BMP, CBC, BMP, HFP, lipase unrevealing. LA 1.1, UA without infection. Admit VBG with pH 7.4, pCO2 and pO2 stable. CXR non-acute.  CT head with no acute intracranial findings, noted acute pansinusitis.    1. COVID 19 Infection: Presented as above. Vaccinated and boosted, denies prior COVID infections. Symptom onset 4/12/23. Admit CXR non-acute. Not requiring O2 on admit, therefore defer decadron or remdesivir. Consult to ID and started and completed course of paxlovid. Symptoms improved.  2. Sepsis: Met criteria with Temp 100.8, tachycardia on presentation. Secondary to COVID as above. CXR and UA without infection. CT head with pansinusitis. Procal negative. On Vanc/Zosyn in ED, held on further antibiotics on admit as suspect viral etiology or sepsis criteria with COVID. Given 1.5 L bolus in ED. Now dry lung strategy with COVID. Treat as discussed and monitor.   3. Acute Metabolic Encephalopathy on Chronic Dementia: Family describes 3-4 month cognitive and functional decline with history of Alzheimers dementia. Per family, prior baseline was alert and oriented with short term memory deficits. Recent baseline waxes and wanes, minimal short term memory. Family feels patient is at recent baseline on admit. Oriented to self, general location, month, year and family on admit. Continued home Remeron. Delirium precautions.  4. Oral thrush: Noted 4/15/23. Nystatin swish and spit continued. 5. Elevated Troponin: Admit Trop 19, second trop 17. Admit EKG with sinus tachycardia, no acute ischemic changes. No chest pain on admit. Suspect demand ischemia with above. No other ischemic eval planned.  6. Acute sinusitis: Diagnosed on admission. Completed Augmentin course 4/18/23. 7. Fall: Secondary to weakness at home. Unable to get off toilet and assisted to ground by family. Denied injuries or hitting head. PT/OT consulted, family interested in SNF on discharge.  8. Hypertension: Per history, continued home Cozaar with hold parameters. Monitor and titrate PRN.  9. Glaucoma: Per history, continued home eye drops.
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Procalcitonin normal, Pyrexia, Sepsis, Sinus tachycardia, Sinusitis
Clinical narrative: Clinical Summary Patient is a 80 y.o. female with a history of Alzheimer's disease, hypertension and glaucoma who presented to hospital 4/13/2023 with fever and altered mental status. Patient found to have COVID 19, labs with BMP, CBC, BMP, HFP, lipase unrevealing. LA 1.1, UA without infection. Admit VBG with pH 7.4, pCO2 and pO2 stable. CXR non-acute.  CT head with no acute intracranial findings, noted acute pansinusitis.    1. COVID 19 Infection: Presented as above. Vaccinated and boosted, denies prior COVID infections. Symptom onset 4/12/23. Admit CXR non-acute. Not requiring O2 on admit, therefore defer decadron or remdesivir. Consult to ID and started and completed course of paxlovid. Symptoms improved.  2. Sepsis: Met criteria with Temp 100.8, tachycardia on presentation. Secondary to COVID as above. CXR and UA without infection. CT head with pansinusitis. Procal negative. On Vanc/Zosyn in ED, held on further antibiotics on admit as suspect viral etiology or sepsis criteria with COVID. Given 1.5 L bolus in ED. Now dry lung strategy with COVID. Treat as discussed and monitor.   3. Acute Metabolic Encephalopathy on Chronic Dementia: Family describes 3-4 month cognitive and functional decline with history of Alzheimers dementia. Per family, prior baseline was alert and oriented with short term memory deficits. Recent baseline waxes and wanes, minimal short term memory. Family feels patient is at recent baseline on admit. Oriented to self, general location, month, year and family on admit. Continued home Remeron. Delirium precautions.  4. Oral thrush: Noted 4/15/23. Nystatin swish and spit continued. 5. Elevated Troponin: Admit Trop 19, second trop 17. Admit EKG with sinus tachycardia, no acute ischemic changes. No chest pain on admit. Suspect demand ischemia with above. No other ischemic eval planned.  6. Acute sinusitis: Diagnosed on admission. Completed Augmentin course 4/18/23. 7. Fall: Secondary to weakness at home. Unable to get off toilet and assisted to ground by family. Denied injuries or hitting head. PT/OT consulted, family interested in SNF on discharge.  8. Hypertension: Per history, continued home Cozaar with hold parameters. Monitor and titrate PRN.  9. Glaucoma: Per history, continued home eye drops.