chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Fatigue
Clinical narrative: Narrative: COVID infection following COVID vaccine series 01/12, MODERNA, dose #1 02/09, MODERNA, dose #2 03/08 COVID swab, result: not detected 09/0 pt cc: cough, fatigue, loss of smell or taste, fever exposure: unknown 09/09 COVID swab, result: detected 09/09 SARS-COV-2 Variant Sequencing result: pending
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Pyrexia, SARS-CoV-2 test, SARS-CoV-2 test positive
Clinical narrative: Narrative: COVID infection following COVID vaccine series 01/12, MODERNA, dose #1 02/09, MODERNA, dose #2 03/08 COVID swab, result: not detected 09/0 pt cc: cough, fatigue, loss of smell or taste, fever exposure: unknown 09/09 COVID swab, result: detected 09/09 SARS-COV-2 Variant Sequencing result: pending
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Cough, Myalgia, Rhinorrhoea, SARS-CoV-2 test
Clinical narrative: Narrative: COVID infection following COVID vaccine series 01/19, Moderna , dose #1 02/16, Moderna , dose #2 09/09 SARS-COV-2 Variant Sequencing result: pending 09/09 COVID swab, result: detected 09/05 pt cc: cough, myalgias, cough, rhinorrhea exposure: unknown
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: Narrative: COVID infection following COVID vaccine series 01/19, Moderna , dose #1 02/16, Moderna , dose #2 09/09 SARS-COV-2 Variant Sequencing result: pending 09/09 COVID swab, result: detected 09/05 pt cc: cough, myalgias, cough, rhinorrhea exposure: unknown
Age: 40.0
Sex: F
Vaccine: COVID19
Symptoms: Ageusia, Anosmia, COVID-19, Dyspnoea, Myalgia
Clinical narrative: Narrative: COVID infection following COVID vaccine series 04/01, MODERNA, dose #1 04/29, MODERNA, dose #2 08/31 pt cc: loss of taste or smell, dyspnea, myalgias, rhinorrhea exposure: unknown 09/02 COVID swab, result: detected 09/02 SARS-COV-2 LINEAGE result: AY .26 09/02 SARS-COV-2 CLADE result: 21 I (DELTA)
Age: 40.0
Sex: F
Vaccine: COVID19
Symptoms: Rhinorrhoea, SARS-CoV-2 test, SARS-CoV-2 test positive
Clinical narrative: Narrative: COVID infection following COVID vaccine series 04/01, MODERNA, dose #1 04/29, MODERNA, dose #2 08/31 pt cc: loss of taste or smell, dyspnea, myalgias, rhinorrhea exposure: unknown 09/02 COVID swab, result: detected 09/02 SARS-COV-2 LINEAGE result: AY .26 09/02 SARS-COV-2 CLADE result: 21 I (DELTA)
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Chest X-ray normal, Chest discomfort, Cough, Dyspnoea
Clinical narrative: Narrative: COVID infection following COVID vaccine series 02/16, Pfizer, dose #1 0/09, Pfizer, dose #2 09/30, Pfizer, dose #3 09/03 COVID swab, result: detected 09/03 DDIMER result: <0.22 09/03 PROCALCITONI result: <0.05 09/03 SARS-COV-2 Variant Sequencing result: pending 09/03 TROPONIN I result: <0.016 09/03 pt cc: cough, chest tightness, and shortness of breath on exertion. exposure: unknown 09/17 COVID swab, result; detected 09/20 TROPONIN I result: <0.016 09/20 DDIMER result: 0.33 09/20 pt admit to ED cc: chest tightness and shortness of breath dx: COVID-19 LOS: 1 09/20 CXR impression: No lobar pneumonia. 09/23 clinically resolved
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea exertional, Fibrin D dimer, Procalcitonin, SARS-CoV-2 test, SARS-CoV-2 test positive
Clinical narrative: Narrative: COVID infection following COVID vaccine series 02/16, Pfizer, dose #1 0/09, Pfizer, dose #2 09/30, Pfizer, dose #3 09/03 COVID swab, result: detected 09/03 DDIMER result: <0.22 09/03 PROCALCITONI result: <0.05 09/03 SARS-COV-2 Variant Sequencing result: pending 09/03 TROPONIN I result: <0.016 09/03 pt cc: cough, chest tightness, and shortness of breath on exertion. exposure: unknown 09/17 COVID swab, result; detected 09/20 TROPONIN I result: <0.016 09/20 DDIMER result: 0.33 09/20 pt admit to ED cc: chest tightness and shortness of breath dx: COVID-19 LOS: 1 09/20 CXR impression: No lobar pneumonia. 09/23 clinically resolved
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Troponin I normal
Clinical narrative: Narrative: COVID infection following COVID vaccine series 02/16, Pfizer, dose #1 0/09, Pfizer, dose #2 09/30, Pfizer, dose #3 09/03 COVID swab, result: detected 09/03 DDIMER result: <0.22 09/03 PROCALCITONI result: <0.05 09/03 SARS-COV-2 Variant Sequencing result: pending 09/03 TROPONIN I result: <0.016 09/03 pt cc: cough, chest tightness, and shortness of breath on exertion. exposure: unknown 09/17 COVID swab, result; detected 09/20 TROPONIN I result: <0.016 09/20 DDIMER result: 0.33 09/20 pt admit to ED cc: chest tightness and shortness of breath dx: COVID-19 LOS: 1 09/20 CXR impression: No lobar pneumonia. 09/23 clinically resolved
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Pyrexia
Clinical narrative: Narrative: COVID infection following COVID vaccine series 02/11, Pfizer, dose#1 03/04, Pfizer, dose #2 07/23 COVID swab, result: NOT detected 08/26 pt cc: cough, loss of taste or smell, fever, exposure: unknown 09/02 COVID swab, result: detected 09/02 SARS-COV-2 LINEAGE result: AY. 4 09/02 SARS-COV-2 CLADE result: 21 J (DELTA)
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: Narrative: COVID infection following COVID vaccine series 02/11, Pfizer, dose#1 03/04, Pfizer, dose #2 07/23 COVID swab, result: NOT detected 08/26 pt cc: cough, loss of taste or smell, fever, exposure: unknown 09/02 COVID swab, result: detected 09/02 SARS-COV-2 LINEAGE result: AY. 4 09/02 SARS-COV-2 CLADE result: 21 J (DELTA)
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: Narrative: COVID infection following COVID vaccine series 04/10 Janssen dose #1 CanO HEALTH (non-VA facility) 09/03 COVID swab, result: detected 09/03 pt cc: exposure: unknown
Age: 43.0
Sex: F
Vaccine: COVID19
Symptoms: Ageusia, Anosmia, Blood fibrinogen increased, C-reactive protein increased, COVID-19
Clinical narrative: Narrative: COVID infection following COVID vaccine series 03/04, Pfizer, dose #1 03/26, Pfizer, dose #2 09/01 pt cc: chills, cough, fatigue, fever, headache, loss of taste or smell, myalgias, rhinorrhea, sore throat exposure: unknown 09/03 SARS-COV-2 Variant Sequencing result: pending 09/04 pt admit to ED cc: chest pain dx: Chest pain r/t COVID LOS: 1 09/04 COVID swab, result: detected 09/04 FIBRINOGEN: 469 09/04 DDIMER: 0.34 09/04 CRP: 4.959 09/04 PT/INR 13.8/1.23 09/04 BinaxNOW COVID-19 Ag: DETECTED 09/04 CXR impression: No radiographic evidence of acute cardiopulmonary pathology. 09/04 CT Head impression: 1. No CT evidence of acute large territory infarction or intracranial hemorrhage. 2. Mild paranasal sinus disease.
Age: 43.0
Sex: F
Vaccine: COVID19
Symptoms: Chest X-ray normal, Chest pain, Chills, Computerised tomogram head abnormal, Cough
Clinical narrative: Narrative: COVID infection following COVID vaccine series 03/04, Pfizer, dose #1 03/26, Pfizer, dose #2 09/01 pt cc: chills, cough, fatigue, fever, headache, loss of taste or smell, myalgias, rhinorrhea, sore throat exposure: unknown 09/03 SARS-COV-2 Variant Sequencing result: pending 09/04 pt admit to ED cc: chest pain dx: Chest pain r/t COVID LOS: 1 09/04 COVID swab, result: detected 09/04 FIBRINOGEN: 469 09/04 DDIMER: 0.34 09/04 CRP: 4.959 09/04 PT/INR 13.8/1.23 09/04 BinaxNOW COVID-19 Ag: DETECTED 09/04 CXR impression: No radiographic evidence of acute cardiopulmonary pathology. 09/04 CT Head impression: 1. No CT evidence of acute large territory infarction or intracranial hemorrhage. 2. Mild paranasal sinus disease.
Age: 43.0
Sex: F
Vaccine: COVID19
Symptoms: Fatigue, Fibrin D dimer, Headache, International normalised ratio increased, Myalgia
Clinical narrative: Narrative: COVID infection following COVID vaccine series 03/04, Pfizer, dose #1 03/26, Pfizer, dose #2 09/01 pt cc: chills, cough, fatigue, fever, headache, loss of taste or smell, myalgias, rhinorrhea, sore throat exposure: unknown 09/03 SARS-COV-2 Variant Sequencing result: pending 09/04 pt admit to ED cc: chest pain dx: Chest pain r/t COVID LOS: 1 09/04 COVID swab, result: detected 09/04 FIBRINOGEN: 469 09/04 DDIMER: 0.34 09/04 CRP: 4.959 09/04 PT/INR 13.8/1.23 09/04 BinaxNOW COVID-19 Ag: DETECTED 09/04 CXR impression: No radiographic evidence of acute cardiopulmonary pathology. 09/04 CT Head impression: 1. No CT evidence of acute large territory infarction or intracranial hemorrhage. 2. Mild paranasal sinus disease.
Age: 43.0
Sex: F
Vaccine: COVID19
Symptoms: Nasal disorder, Oropharyngeal pain, Prothrombin time prolonged, Pyrexia, Rhinorrhoea
Clinical narrative: Narrative: COVID infection following COVID vaccine series 03/04, Pfizer, dose #1 03/26, Pfizer, dose #2 09/01 pt cc: chills, cough, fatigue, fever, headache, loss of taste or smell, myalgias, rhinorrhea, sore throat exposure: unknown 09/03 SARS-COV-2 Variant Sequencing result: pending 09/04 pt admit to ED cc: chest pain dx: Chest pain r/t COVID LOS: 1 09/04 COVID swab, result: detected 09/04 FIBRINOGEN: 469 09/04 DDIMER: 0.34 09/04 CRP: 4.959 09/04 PT/INR 13.8/1.23 09/04 BinaxNOW COVID-19 Ag: DETECTED 09/04 CXR impression: No radiographic evidence of acute cardiopulmonary pathology. 09/04 CT Head impression: 1. No CT evidence of acute large territory infarction or intracranial hemorrhage. 2. Mild paranasal sinus disease.
Age: 43.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test, SARS-CoV-2 test positive
Clinical narrative: Narrative: COVID infection following COVID vaccine series 03/04, Pfizer, dose #1 03/26, Pfizer, dose #2 09/01 pt cc: chills, cough, fatigue, fever, headache, loss of taste or smell, myalgias, rhinorrhea, sore throat exposure: unknown 09/03 SARS-COV-2 Variant Sequencing result: pending 09/04 pt admit to ED cc: chest pain dx: Chest pain r/t COVID LOS: 1 09/04 COVID swab, result: detected 09/04 FIBRINOGEN: 469 09/04 DDIMER: 0.34 09/04 CRP: 4.959 09/04 PT/INR 13.8/1.23 09/04 BinaxNOW COVID-19 Ag: DETECTED 09/04 CXR impression: No radiographic evidence of acute cardiopulmonary pathology. 09/04 CT Head impression: 1. No CT evidence of acute large territory infarction or intracranial hemorrhage. 2. Mild paranasal sinus disease.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: Narrative: COVID infection following COVID vaccine series 01/19, MODERNA, dose #1  02/16, MODERNA, dose #2 09/03 COVID swab, result: detected 09/03 pt cc: exposure: unknown 09/24 COVID swab, result: not detected
Age: 74.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Ageusia, Anosmia, Atelectasis, COVID-19, Chest X-ray abnormal
Clinical narrative: Narrative:  COVID infection following COVID vaccine series 01/23, Pfizer, dose #1 02/16, Pfizer, dose #2 10/05, Pfizer, dose #3 09/03 SARS-COV-2 Variant Sequencing result: pending 09/03 COVID swab, result" detected 09/04 CXR impression: Streaky linear bibasilar opacities likely representing areas of basilar atelectasis. No definite radiographic evidence of pneumonia or overt pulmonary 09/04 pt admit to ED cc: cough and low 02 stat dx: covid 19 LOS: 1 09/10 clinically resolved 09/30 pt cc: cough, loss of taste or smell, mylagias, rhinorrhea exposure: unknown
Age: 74.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Cough, Lung opacity, Myalgia, Oxygen saturation decreased, Rhinorrhoea
Clinical narrative: Narrative:  COVID infection following COVID vaccine series 01/23, Pfizer, dose #1 02/16, Pfizer, dose #2 10/05, Pfizer, dose #3 09/03 SARS-COV-2 Variant Sequencing result: pending 09/03 COVID swab, result" detected 09/04 CXR impression: Streaky linear bibasilar opacities likely representing areas of basilar atelectasis. No definite radiographic evidence of pneumonia or overt pulmonary 09/04 pt admit to ED cc: cough and low 02 stat dx: covid 19 LOS: 1 09/10 clinically resolved 09/30 pt cc: cough, loss of taste or smell, mylagias, rhinorrhea exposure: unknown
Age: 74.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: SARS-CoV-2 test, SARS-CoV-2 test positive
Clinical narrative: Narrative:  COVID infection following COVID vaccine series 01/23, Pfizer, dose #1 02/16, Pfizer, dose #2 10/05, Pfizer, dose #3 09/03 SARS-COV-2 Variant Sequencing result: pending 09/03 COVID swab, result" detected 09/04 CXR impression: Streaky linear bibasilar opacities likely representing areas of basilar atelectasis. No definite radiographic evidence of pneumonia or overt pulmonary 09/04 pt admit to ED cc: cough and low 02 stat dx: covid 19 LOS: 1 09/10 clinically resolved 09/30 pt cc: cough, loss of taste or smell, mylagias, rhinorrhea exposure: unknown
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: Narrative: COVID infection following COVID vaccine series 01/18, Pfizer, dose #1 02/08, Pfizer, dose #2 08/13 COVID swab, result: not detected 09/03 COVID swab, result: detected 09/06 pt cc: exposure: unknown
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test, SARS-CoV-2 test positive
Clinical narrative: Narrative: COVID infection following COVID vaccine series 01/08, Pfizer, dose #1 (NON-FACILITY) 01/29, Pfizer, dose# 2 (NON-FACILITY) 08/03 COVID swab, result: detected 09/03 SARS-COV-2 Variant Sequencing result: pending 09/03
Age: 48.0
Sex: F
Vaccine: COVID19
Symptoms: Arthralgia, Fatigue, Headache, Lymph node pain, Pyrexia
Clinical narrative: Headache, Arthralgia, Fever, fatigue, tender lymph nodes on side of injection  Narrative:
Age: 88.0
Sex: M
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Narrative:  87 year old male, with CAD, TIA, DM II, CKD III, HFpEF, HLD, HTN, COPD, polymyalgia rheumatica, s/p L BKA 2.2 nonhealing foot ulcer died at home on 9/17/2021. Pt had received covid vaccines on 4/5/2021 & 5/3/2021. Likely vaccines are not related to pt's death given pt's advanced age & medical issues & long time frame between date of vaccines given & date of death.
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Abdominal discomfort, Asthenia, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal
Clinical narrative: Narrative: Patient is a 74 year old M, who relates about a 10 day history of diarrhea, progressive weakness, cough and shortness of breath. He notes "everyone at home has COVID", and states he has just been miserable this past week, having no appetite, minimal oral intake and not been able to take his oral diabetic medications. Presents to agency ED and noted to be COVID positive. Clinical and radiographic evidence of COVID PNA also apparent. Admitted to COVID ward for above and related. HOSPITAL COURSE: Slow, but steady improvement in GI distress, oral tolerance and lastly pulmonary status. Unable to fully wean off oxygen, but able to reasonably ambulate with oxygen support. Discharged to home on O2 via nasal canula.
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Cough, Decreased appetite, Diarrhoea, Dyspnoea, Exposure to SARS-CoV-2
Clinical narrative: Narrative: Patient is a 74 year old M, who relates about a 10 day history of diarrhea, progressive weakness, cough and shortness of breath. He notes "everyone at home has COVID", and states he has just been miserable this past week, having no appetite, minimal oral intake and not been able to take his oral diabetic medications. Presents to agency ED and noted to be COVID positive. Clinical and radiographic evidence of COVID PNA also apparent. Admitted to COVID ward for above and related. HOSPITAL COURSE: Slow, but steady improvement in GI distress, oral tolerance and lastly pulmonary status. Unable to fully wean off oxygen, but able to reasonably ambulate with oxygen support. Discharged to home on O2 via nasal canula.
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Feeling abnormal, Hypophagia, SARS-CoV-2 test positive, Therapy interrupted
Clinical narrative: Narrative: Patient is a 74 year old M, who relates about a 10 day history of diarrhea, progressive weakness, cough and shortness of breath. He notes "everyone at home has COVID", and states he has just been miserable this past week, having no appetite, minimal oral intake and not been able to take his oral diabetic medications. Presents to agency ED and noted to be COVID positive. Clinical and radiographic evidence of COVID PNA also apparent. Admitted to COVID ward for above and related. HOSPITAL COURSE: Slow, but steady improvement in GI distress, oral tolerance and lastly pulmonary status. Unable to fully wean off oxygen, but able to reasonably ambulate with oxygen support. Discharged to home on O2 via nasal canula.
Age: 57.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Chest pain, Cough, Dyspnoea, Vaccine breakthrough infection
Clinical narrative: Narrative: Breakthrough Covid-19: history of CAD and prior MI which was medically managed as well as HIV infection who presents to the ED with cough, shortness of breath, and chest pain.
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Vaccine breakthrough infection
Clinical narrative: Narrative: Breakthrough COVID infection requiring hospitalization
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19
Clinical narrative: Narrative:  Patient was hospitalized on a COVID unit and initiated on dexamethasone and Remdesivir 5 day course each. He had O2 supplementation via nasal cannula as well as inhaled bronchodilators and supportive care with expectorants and mucolytics. Patient improved with the above regimen and by 9/7/2021 was feeling good spirits. He was tolerated by mouth and ambulating in his room with oxygen supplementation at 3-4 L/m. He was deemed stable for discharge home with close outpatient follow-up for posthospitalization reevaluation as well as oxygen weaning.
Age: 97.0
Sex: M
Vaccine: COVID19
Symptoms: Bladder irrigation, Cholecystitis, Death, Transurethral bladder resection
Clinical narrative: Narrative: 97yo male patient on 08/20/21 was admitted to hospital (non-agency hospital) after ED self presented for Cholecystitis . Pt had a TURBT on 9/1/21 and continuous bladder irrigation post procedure. On 9/7/21 pt's daughter called his agency PCC to inquire about hospice care for her father. Two days later pt died on 9/9/21 at hospital, likely from complication of this illness & procedure given pt's advanced age. Pt had received covid vaccinations on 1/11/21 & 2/8/21. This death is likely not related to the vaccinations due to comorbidities, age and length of time from vaccine administration.
Age: 69.0
Sex: M
Vaccine: FLU4
Symptoms: Asthenia, Axonal neuropathy, Dehydration, Diarrhoea, Gait inability
Clinical narrative: Narrative: History of Present Illness: October had dirraheal illness octiober 7th and 10 days later admitted in hospital with dehyration and weakness, also had numbness fingers,no c/o numbness feet was in hospital 1 week and discharged to skilled nursing facilty for 8 weeks.Initial 4 weeks after admission in skilled nursing facility could not walk then improved over the next 3-4 weeks and now walking and improved strenght both armn and legs h/o some weight loss last year when he was in nursing home now weight is stable patient was told statin medication caused his weakness,did not have an EMG study no c/o neck pain,no c/o headaches,no h/o strokes h/o TB exposure and was on medication for 6 months Neurological examination: Awake , alert , oriented to person, place and date, Pupils 2-3 mm reactive to light sym ; primary gaze midline, extraocular movements intact ; no ptosis, visual fields intact to confrontation .Touch and pinprick intact on the face, no facial asymmetry, no facial muscle weakness ; hearing grossly intact, shoulder shrug and head turning good strength bilaterally; tongue midline with no atrophy Rapid alternating movements very slow bilaterally, neck flexor neck & extensor strength gave good resistance ; strength gave good resistance both HF,KE,KF both lower extremities left bi and delt 4- right delt 4- BI 4+ tri 4+ both right interossei 1+,left interossei 1-,right APB 2-,left APB 1+ with wasting left APB and less right APB , also both interossei wasted right more so, finger flexors good strenght,finger extensors no mvt,WE 1+ to 1- right foot DF 2+ to 3-,left DF 3- to 3+,PF gave good resisatnce could not see any faciculations DTR's 1+ knees symmetric ; tone normal upper and lower extremities; plantar reflexes flexor , no tremors resting or postural; no bradykinesia. No dysmetria on finger to nose and heel to shin testing. Touch and pinprick intact hands and feet ; position sense seems intact feet. Gait exam : normal base and stride steady gait,Romberg's test negative. Impression: Patient with severe motor axonal neuropathy with clinical h/o significant weakness last several months with some improvement but still has prominent weakness hands. Discussed cannot exclude multifocal motor neuropathy,another possiblity based on antecedent diarrheal illness may have had Guillain Barre motor axonal neuropathy variant 6 months ago with some improvement based on clinical history. Recommended a trial of 2gm/kg IVIG over 5 days.Discussed the risks with IVIG and potential benefits.Patient needs to continue regular Physical therapy and occupational therapy.
Age: 69.0
Sex: M
Vaccine: FLU4
Symptoms: Guillain-Barre syndrome, Hypoaesthesia, Immunoglobulin therapy, Muscle atrophy, Muscular weakness
Clinical narrative: Narrative: History of Present Illness: October had dirraheal illness octiober 7th and 10 days later admitted in hospital with dehyration and weakness, also had numbness fingers,no c/o numbness feet was in hospital 1 week and discharged to skilled nursing facilty for 8 weeks.Initial 4 weeks after admission in skilled nursing facility could not walk then improved over the next 3-4 weeks and now walking and improved strenght both armn and legs h/o some weight loss last year when he was in nursing home now weight is stable patient was told statin medication caused his weakness,did not have an EMG study no c/o neck pain,no c/o headaches,no h/o strokes h/o TB exposure and was on medication for 6 months Neurological examination: Awake , alert , oriented to person, place and date, Pupils 2-3 mm reactive to light sym ; primary gaze midline, extraocular movements intact ; no ptosis, visual fields intact to confrontation .Touch and pinprick intact on the face, no facial asymmetry, no facial muscle weakness ; hearing grossly intact, shoulder shrug and head turning good strength bilaterally; tongue midline with no atrophy Rapid alternating movements very slow bilaterally, neck flexor neck & extensor strength gave good resistance ; strength gave good resistance both HF,KE,KF both lower extremities left bi and delt 4- right delt 4- BI 4+ tri 4+ both right interossei 1+,left interossei 1-,right APB 2-,left APB 1+ with wasting left APB and less right APB , also both interossei wasted right more so, finger flexors good strenght,finger extensors no mvt,WE 1+ to 1- right foot DF 2+ to 3-,left DF 3- to 3+,PF gave good resisatnce could not see any faciculations DTR's 1+ knees symmetric ; tone normal upper and lower extremities; plantar reflexes flexor , no tremors resting or postural; no bradykinesia. No dysmetria on finger to nose and heel to shin testing. Touch and pinprick intact hands and feet ; position sense seems intact feet. Gait exam : normal base and stride steady gait,Romberg's test negative. Impression: Patient with severe motor axonal neuropathy with clinical h/o significant weakness last several months with some improvement but still has prominent weakness hands. Discussed cannot exclude multifocal motor neuropathy,another possiblity based on antecedent diarrheal illness may have had Guillain Barre motor axonal neuropathy variant 6 months ago with some improvement based on clinical history. Recommended a trial of 2gm/kg IVIG over 5 days.Discussed the risks with IVIG and potential benefits.Patient needs to continue regular Physical therapy and occupational therapy.
Age: 69.0
Sex: M
Vaccine: FLU4
Symptoms: Neurological examination abnormal, Romberg test
Clinical narrative: Narrative: History of Present Illness: October had dirraheal illness octiober 7th and 10 days later admitted in hospital with dehyration and weakness, also had numbness fingers,no c/o numbness feet was in hospital 1 week and discharged to skilled nursing facilty for 8 weeks.Initial 4 weeks after admission in skilled nursing facility could not walk then improved over the next 3-4 weeks and now walking and improved strenght both armn and legs h/o some weight loss last year when he was in nursing home now weight is stable patient was told statin medication caused his weakness,did not have an EMG study no c/o neck pain,no c/o headaches,no h/o strokes h/o TB exposure and was on medication for 6 months Neurological examination: Awake , alert , oriented to person, place and date, Pupils 2-3 mm reactive to light sym ; primary gaze midline, extraocular movements intact ; no ptosis, visual fields intact to confrontation .Touch and pinprick intact on the face, no facial asymmetry, no facial muscle weakness ; hearing grossly intact, shoulder shrug and head turning good strength bilaterally; tongue midline with no atrophy Rapid alternating movements very slow bilaterally, neck flexor neck & extensor strength gave good resistance ; strength gave good resistance both HF,KE,KF both lower extremities left bi and delt 4- right delt 4- BI 4+ tri 4+ both right interossei 1+,left interossei 1-,right APB 2-,left APB 1+ with wasting left APB and less right APB , also both interossei wasted right more so, finger flexors good strenght,finger extensors no mvt,WE 1+ to 1- right foot DF 2+ to 3-,left DF 3- to 3+,PF gave good resisatnce could not see any faciculations DTR's 1+ knees symmetric ; tone normal upper and lower extremities; plantar reflexes flexor , no tremors resting or postural; no bradykinesia. No dysmetria on finger to nose and heel to shin testing. Touch and pinprick intact hands and feet ; position sense seems intact feet. Gait exam : normal base and stride steady gait,Romberg's test negative. Impression: Patient with severe motor axonal neuropathy with clinical h/o significant weakness last several months with some improvement but still has prominent weakness hands. Discussed cannot exclude multifocal motor neuropathy,another possiblity based on antecedent diarrheal illness may have had Guillain Barre motor axonal neuropathy variant 6 months ago with some improvement based on clinical history. Recommended a trial of 2gm/kg IVIG over 5 days.Discussed the risks with IVIG and potential benefits.Patient needs to continue regular Physical therapy and occupational therapy.
Age: 68.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Dyspnoea, Dyspnoea exertional, Productive cough, Vaccine breakthrough infection
Clinical narrative: Narrative: Breakthrough Delta Variant COVID infection requiring hospitalization: Patient presents w 2 wks of increasing SOB, DOE and productive cough.
Age: 93.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Aortic arteriosclerosis, Bacteraemia, COVID-19, Central venous catheterisation, Chest X-ray abnormal
Clinical narrative: Narrative: Admission Date: Aug 11,2021 Discharge Date: Sep 7,2021 Condition of patient at discharge: Deceased 92 yo male initially admitted for bacteremia likely secondary to urinary source (E. faecalis/pseudomonas UTI). Pt clinically improved with Zosyn. Plan was to discharge home with Zosyn through PICC line, however, patient acquired COVID during hospitalization despite being fully vaccinated with Moderna COVID vaccine on 1/12/2021 and 2/9/2021. Desaturations with minimal exertion and conversation. Required 8L oxymizer to maintain SpO2 >90%. Transferred to ICU on 8L oxymizer. Oxygen increased to 45L 75% FiO2. Pt maintained O2 sats well. Mental status waxed and waned throughout ICU stay. Dexamethasone and remdesivir were continued. He was eventually transferred out of ICU on high flow nasal canula 50L/85%. Following transfer to floor, patient had persistent O2 requirement that ultimately worsened to high flow nasal canula 50L/100%. Repeat CXR revealed worsened total opacification of left lung field and US confirmed effusion. Procal was elevated and hospital-acquired pneumonia coverage was started with vancomycin/cefepime. Unfortunately, patients O2 requirements failed to improved and he passed away peacefully on 9/7.
Age: 93.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Cough, Death, Enterococcal infection, Intensive care, Lung disorder
Clinical narrative: Narrative: Admission Date: Aug 11,2021 Discharge Date: Sep 7,2021 Condition of patient at discharge: Deceased 92 yo male initially admitted for bacteremia likely secondary to urinary source (E. faecalis/pseudomonas UTI). Pt clinically improved with Zosyn. Plan was to discharge home with Zosyn through PICC line, however, patient acquired COVID during hospitalization despite being fully vaccinated with Moderna COVID vaccine on 1/12/2021 and 2/9/2021. Desaturations with minimal exertion and conversation. Required 8L oxymizer to maintain SpO2 >90%. Transferred to ICU on 8L oxymizer. Oxygen increased to 45L 75% FiO2. Pt maintained O2 sats well. Mental status waxed and waned throughout ICU stay. Dexamethasone and remdesivir were continued. He was eventually transferred out of ICU on high flow nasal canula 50L/85%. Following transfer to floor, patient had persistent O2 requirement that ultimately worsened to high flow nasal canula 50L/100%. Repeat CXR revealed worsened total opacification of left lung field and US confirmed effusion. Procal was elevated and hospital-acquired pneumonia coverage was started with vancomycin/cefepime. Unfortunately, patients O2 requirements failed to improved and he passed away peacefully on 9/7.
Age: 93.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Lung opacity, Mental status changes, Oxygen saturation decreased, Pleural effusion, Pneumonia
Clinical narrative: Narrative: Admission Date: Aug 11,2021 Discharge Date: Sep 7,2021 Condition of patient at discharge: Deceased 92 yo male initially admitted for bacteremia likely secondary to urinary source (E. faecalis/pseudomonas UTI). Pt clinically improved with Zosyn. Plan was to discharge home with Zosyn through PICC line, however, patient acquired COVID during hospitalization despite being fully vaccinated with Moderna COVID vaccine on 1/12/2021 and 2/9/2021. Desaturations with minimal exertion and conversation. Required 8L oxymizer to maintain SpO2 >90%. Transferred to ICU on 8L oxymizer. Oxygen increased to 45L 75% FiO2. Pt maintained O2 sats well. Mental status waxed and waned throughout ICU stay. Dexamethasone and remdesivir were continued. He was eventually transferred out of ICU on high flow nasal canula 50L/85%. Following transfer to floor, patient had persistent O2 requirement that ultimately worsened to high flow nasal canula 50L/100%. Repeat CXR revealed worsened total opacification of left lung field and US confirmed effusion. Procal was elevated and hospital-acquired pneumonia coverage was started with vancomycin/cefepime. Unfortunately, patients O2 requirements failed to improved and he passed away peacefully on 9/7.
Age: 93.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Procalcitonin increased, Pulmonary calcification, Pulmonary oedema, SARS-CoV-2 test positive, Ultrasound scan abnormal
Clinical narrative: Narrative: Admission Date: Aug 11,2021 Discharge Date: Sep 7,2021 Condition of patient at discharge: Deceased 92 yo male initially admitted for bacteremia likely secondary to urinary source (E. faecalis/pseudomonas UTI). Pt clinically improved with Zosyn. Plan was to discharge home with Zosyn through PICC line, however, patient acquired COVID during hospitalization despite being fully vaccinated with Moderna COVID vaccine on 1/12/2021 and 2/9/2021. Desaturations with minimal exertion and conversation. Required 8L oxymizer to maintain SpO2 >90%. Transferred to ICU on 8L oxymizer. Oxygen increased to 45L 75% FiO2. Pt maintained O2 sats well. Mental status waxed and waned throughout ICU stay. Dexamethasone and remdesivir were continued. He was eventually transferred out of ICU on high flow nasal canula 50L/85%. Following transfer to floor, patient had persistent O2 requirement that ultimately worsened to high flow nasal canula 50L/100%. Repeat CXR revealed worsened total opacification of left lung field and US confirmed effusion. Procal was elevated and hospital-acquired pneumonia coverage was started with vancomycin/cefepime. Unfortunately, patients O2 requirements failed to improved and he passed away peacefully on 9/7.
Age: 93.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Urinary tract infection pseudomonal
Clinical narrative: Narrative: Admission Date: Aug 11,2021 Discharge Date: Sep 7,2021 Condition of patient at discharge: Deceased 92 yo male initially admitted for bacteremia likely secondary to urinary source (E. faecalis/pseudomonas UTI). Pt clinically improved with Zosyn. Plan was to discharge home with Zosyn through PICC line, however, patient acquired COVID during hospitalization despite being fully vaccinated with Moderna COVID vaccine on 1/12/2021 and 2/9/2021. Desaturations with minimal exertion and conversation. Required 8L oxymizer to maintain SpO2 >90%. Transferred to ICU on 8L oxymizer. Oxygen increased to 45L 75% FiO2. Pt maintained O2 sats well. Mental status waxed and waned throughout ICU stay. Dexamethasone and remdesivir were continued. He was eventually transferred out of ICU on high flow nasal canula 50L/85%. Following transfer to floor, patient had persistent O2 requirement that ultimately worsened to high flow nasal canula 50L/100%. Repeat CXR revealed worsened total opacification of left lung field and US confirmed effusion. Procal was elevated and hospital-acquired pneumonia coverage was started with vancomycin/cefepime. Unfortunately, patients O2 requirements failed to improved and he passed away peacefully on 9/7.
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Vaccine breakthrough infection
Clinical narrative: Narrative:  Breakthrough COVID infection requiring hospitalization
Age: 75.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Acute respiratory distress syndrome, COVID-19, COVID-19 pneumonia, Cough, Death
Clinical narrative: Narrative:  74 y/o with PMHx significant for HTN, HLD, T2DM, Obesity, CKD III, OSA, who presented to an OSH with 6 days of cough, SOB, fever, generalized fatigue, transferred after being found to be COVID-19 positive with worsening hypoxia. Hospitalized with ARDS 2/2 severe COVID-19 PNA. On 8/29 in ED was on 6L NC with SpO2 85% was transitioned next day to high flow NC at 100% and 50. Unfortunately, unable to tolerate and was intubated the following day (8/31). Patient remained intubated until date of death (9/25/2021). Received the following COVID treatment: EUA Tocilizumab IV 800mg once (day 1 of ICU care), Remdesivir 5 doses total (received 1st dose in outside ED), and daily Dexamethasone. COVID vaccination: Moderna x 2 (Feb and March 2021)
Age: 75.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Dyspnoea, Endotracheal intubation, Fatigue, Hypoxia, Intensive care
Clinical narrative: Narrative:  74 y/o with PMHx significant for HTN, HLD, T2DM, Obesity, CKD III, OSA, who presented to an OSH with 6 days of cough, SOB, fever, generalized fatigue, transferred after being found to be COVID-19 positive with worsening hypoxia. Hospitalized with ARDS 2/2 severe COVID-19 PNA. On 8/29 in ED was on 6L NC with SpO2 85% was transitioned next day to high flow NC at 100% and 50. Unfortunately, unable to tolerate and was intubated the following day (8/31). Patient remained intubated until date of death (9/25/2021). Received the following COVID treatment: EUA Tocilizumab IV 800mg once (day 1 of ICU care), Remdesivir 5 doses total (received 1st dose in outside ED), and daily Dexamethasone. COVID vaccination: Moderna x 2 (Feb and March 2021)
Age: 75.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Pyrexia, SARS-CoV-2 test positive
Clinical narrative: Narrative:  74 y/o with PMHx significant for HTN, HLD, T2DM, Obesity, CKD III, OSA, who presented to an OSH with 6 days of cough, SOB, fever, generalized fatigue, transferred after being found to be COVID-19 positive with worsening hypoxia. Hospitalized with ARDS 2/2 severe COVID-19 PNA. On 8/29 in ED was on 6L NC with SpO2 85% was transitioned next day to high flow NC at 100% and 50. Unfortunately, unable to tolerate and was intubated the following day (8/31). Patient remained intubated until date of death (9/25/2021). Received the following COVID treatment: EUA Tocilizumab IV 800mg once (day 1 of ICU care), Remdesivir 5 doses total (received 1st dose in outside ED), and daily Dexamethasone. COVID vaccination: Moderna x 2 (Feb and March 2021)
Age: 36.0
Sex: F
Vaccine: COVID19
Symptoms: Apnoea, Autopsy, Bipolar disorder, Cardiac arrest, Cardio-respiratory arrest
Clinical narrative: Narrative:  psychiatric history of Schizoaffective disorder, h/o catatonic episodes, selective mutism, complex PTSD, and multiple psychiatric admissions. Unexpected Death. She was admitted for schizophrenia and bipolar disorder. Coded 5 days after 2nd Pfizer COVID dose. Unknown cause of apnea/cardiac arrest. Pt also received clozapine and ziprasidone night before event. Pt had been compliant with psych meds as outpt. RCA occurred. Autopsy revealed no abnormalities with brain, heart or lungs, no embolic events seen.
Age: 36.0
Sex: F
Vaccine: COVID19
Symptoms: Condition aggravated, Death, Schizophrenia
Clinical narrative: Narrative:  psychiatric history of Schizoaffective disorder, h/o catatonic episodes, selective mutism, complex PTSD, and multiple psychiatric admissions. Unexpected Death. She was admitted for schizophrenia and bipolar disorder. Coded 5 days after 2nd Pfizer COVID dose. Unknown cause of apnea/cardiac arrest. Pt also received clozapine and ziprasidone night before event. Pt had been compliant with psych meds as outpt. RCA occurred. Autopsy revealed no abnormalities with brain, heart or lungs, no embolic events seen.
Age: 87.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Acquired diaphragmatic eventration, Agitation, Anticoagulant therapy, Atrial fibrillation, Blood creatinine increased
Clinical narrative: Narrative: Patient is 87 yo male with a past medical history of aortic stenosis s/p TAVR, CAD s/p stent to RCA 2014, Afib, HTN, and neurocognitive disorder who presented to Emergency Department on 8/9/2021 for worsening SOB in setting of COVID infection. Patient recently evaluated in ED 5 days prior for "not feeling up to par" and "fatigue" and found to be COVID positive despite being fully vaccinated with COVID Pfizer vaccine. At that time he refused monoclonal antibody treatment and was discharged home with no medications for COVID. On 8/9/2021, at the 2nd ER visit, the patient was hypoxic requiring 2L O2 and Afib RVR with rates in 140s. Patient also with new hypotension with BP 86/63. Patient initially admitted to floor and started treatment for COVID PNA with antibiotics, steroids and remdesivir. Transferred to the ICU 8/11/21 for afib with RVR. Heart rate was difficult to control with rate control medications, so after discussions with family decision made to start on amiodarone and heparin infusions. He reverted to NSR after starting amiodarone but continued to require supplemental O2. He was intermittently agitated and required dexmedetomidine infusion. Patient's mental status did not improve during admission. He remained confused, eventually unable to communicate with staff or family, and stopped eating. Palliative care consulted and family made decision to transition to comfort care. On the evening of 8/21, patient had no respirations with asystole on telemetry monitor. Exam with no chest rise, no heart sounds and no carotid pulse after 1 min. Pupils fixed and dilated. Time of death 21:58.
Age: 87.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Blood urea increased, COVID-19, COVID-19 pneumonia, Cardiac arrest, Cardiac telemetry abnormal
Clinical narrative: Narrative: Patient is 87 yo male with a past medical history of aortic stenosis s/p TAVR, CAD s/p stent to RCA 2014, Afib, HTN, and neurocognitive disorder who presented to Emergency Department on 8/9/2021 for worsening SOB in setting of COVID infection. Patient recently evaluated in ED 5 days prior for "not feeling up to par" and "fatigue" and found to be COVID positive despite being fully vaccinated with COVID Pfizer vaccine. At that time he refused monoclonal antibody treatment and was discharged home with no medications for COVID. On 8/9/2021, at the 2nd ER visit, the patient was hypoxic requiring 2L O2 and Afib RVR with rates in 140s. Patient also with new hypotension with BP 86/63. Patient initially admitted to floor and started treatment for COVID PNA with antibiotics, steroids and remdesivir. Transferred to the ICU 8/11/21 for afib with RVR. Heart rate was difficult to control with rate control medications, so after discussions with family decision made to start on amiodarone and heparin infusions. He reverted to NSR after starting amiodarone but continued to require supplemental O2. He was intermittently agitated and required dexmedetomidine infusion. Patient's mental status did not improve during admission. He remained confused, eventually unable to communicate with staff or family, and stopped eating. Palliative care consulted and family made decision to transition to comfort care. On the evening of 8/21, patient had no respirations with asystole on telemetry monitor. Exam with no chest rise, no heart sounds and no carotid pulse after 1 min. Pupils fixed and dilated. Time of death 21:58.
Age: 87.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Cardioversion, Chest X-ray abnormal, Confusional state, Death, Dyspnoea
Clinical narrative: Narrative: Patient is 87 yo male with a past medical history of aortic stenosis s/p TAVR, CAD s/p stent to RCA 2014, Afib, HTN, and neurocognitive disorder who presented to Emergency Department on 8/9/2021 for worsening SOB in setting of COVID infection. Patient recently evaluated in ED 5 days prior for "not feeling up to par" and "fatigue" and found to be COVID positive despite being fully vaccinated with COVID Pfizer vaccine. At that time he refused monoclonal antibody treatment and was discharged home with no medications for COVID. On 8/9/2021, at the 2nd ER visit, the patient was hypoxic requiring 2L O2 and Afib RVR with rates in 140s. Patient also with new hypotension with BP 86/63. Patient initially admitted to floor and started treatment for COVID PNA with antibiotics, steroids and remdesivir. Transferred to the ICU 8/11/21 for afib with RVR. Heart rate was difficult to control with rate control medications, so after discussions with family decision made to start on amiodarone and heparin infusions. He reverted to NSR after starting amiodarone but continued to require supplemental O2. He was intermittently agitated and required dexmedetomidine infusion. Patient's mental status did not improve during admission. He remained confused, eventually unable to communicate with staff or family, and stopped eating. Palliative care consulted and family made decision to transition to comfort care. On the evening of 8/21, patient had no respirations with asystole on telemetry monitor. Exam with no chest rise, no heart sounds and no carotid pulse after 1 min. Pupils fixed and dilated. Time of death 21:58.
Age: 87.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Fatigue, Feeling abnormal, Haemoglobin decreased, Heart rate abnormal, Hypotension
Clinical narrative: Narrative: Patient is 87 yo male with a past medical history of aortic stenosis s/p TAVR, CAD s/p stent to RCA 2014, Afib, HTN, and neurocognitive disorder who presented to Emergency Department on 8/9/2021 for worsening SOB in setting of COVID infection. Patient recently evaluated in ED 5 days prior for "not feeling up to par" and "fatigue" and found to be COVID positive despite being fully vaccinated with COVID Pfizer vaccine. At that time he refused monoclonal antibody treatment and was discharged home with no medications for COVID. On 8/9/2021, at the 2nd ER visit, the patient was hypoxic requiring 2L O2 and Afib RVR with rates in 140s. Patient also with new hypotension with BP 86/63. Patient initially admitted to floor and started treatment for COVID PNA with antibiotics, steroids and remdesivir. Transferred to the ICU 8/11/21 for afib with RVR. Heart rate was difficult to control with rate control medications, so after discussions with family decision made to start on amiodarone and heparin infusions. He reverted to NSR after starting amiodarone but continued to require supplemental O2. He was intermittently agitated and required dexmedetomidine infusion. Patient's mental status did not improve during admission. He remained confused, eventually unable to communicate with staff or family, and stopped eating. Palliative care consulted and family made decision to transition to comfort care. On the evening of 8/21, patient had no respirations with asystole on telemetry monitor. Exam with no chest rise, no heart sounds and no carotid pulse after 1 min. Pupils fixed and dilated. Time of death 21:58.
Age: 87.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Hypoxia, Intensive care, Lung opacity, Platelet count normal, Pupil fixed
Clinical narrative: Narrative: Patient is 87 yo male with a past medical history of aortic stenosis s/p TAVR, CAD s/p stent to RCA 2014, Afib, HTN, and neurocognitive disorder who presented to Emergency Department on 8/9/2021 for worsening SOB in setting of COVID infection. Patient recently evaluated in ED 5 days prior for "not feeling up to par" and "fatigue" and found to be COVID positive despite being fully vaccinated with COVID Pfizer vaccine. At that time he refused monoclonal antibody treatment and was discharged home with no medications for COVID. On 8/9/2021, at the 2nd ER visit, the patient was hypoxic requiring 2L O2 and Afib RVR with rates in 140s. Patient also with new hypotension with BP 86/63. Patient initially admitted to floor and started treatment for COVID PNA with antibiotics, steroids and remdesivir. Transferred to the ICU 8/11/21 for afib with RVR. Heart rate was difficult to control with rate control medications, so after discussions with family decision made to start on amiodarone and heparin infusions. He reverted to NSR after starting amiodarone but continued to require supplemental O2. He was intermittently agitated and required dexmedetomidine infusion. Patient's mental status did not improve during admission. He remained confused, eventually unable to communicate with staff or family, and stopped eating. Palliative care consulted and family made decision to transition to comfort care. On the evening of 8/21, patient had no respirations with asystole on telemetry monitor. Exam with no chest rise, no heart sounds and no carotid pulse after 1 min. Pupils fixed and dilated. Time of death 21:58.
Age: 87.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: SARS-CoV-2 test positive, Sinus rhythm, White blood cell count increased
Clinical narrative: Narrative: Patient is 87 yo male with a past medical history of aortic stenosis s/p TAVR, CAD s/p stent to RCA 2014, Afib, HTN, and neurocognitive disorder who presented to Emergency Department on 8/9/2021 for worsening SOB in setting of COVID infection. Patient recently evaluated in ED 5 days prior for "not feeling up to par" and "fatigue" and found to be COVID positive despite being fully vaccinated with COVID Pfizer vaccine. At that time he refused monoclonal antibody treatment and was discharged home with no medications for COVID. On 8/9/2021, at the 2nd ER visit, the patient was hypoxic requiring 2L O2 and Afib RVR with rates in 140s. Patient also with new hypotension with BP 86/63. Patient initially admitted to floor and started treatment for COVID PNA with antibiotics, steroids and remdesivir. Transferred to the ICU 8/11/21 for afib with RVR. Heart rate was difficult to control with rate control medications, so after discussions with family decision made to start on amiodarone and heparin infusions. He reverted to NSR after starting amiodarone but continued to require supplemental O2. He was intermittently agitated and required dexmedetomidine infusion. Patient's mental status did not improve during admission. He remained confused, eventually unable to communicate with staff or family, and stopped eating. Palliative care consulted and family made decision to transition to comfort care. On the evening of 8/21, patient had no respirations with asystole on telemetry monitor. Exam with no chest rise, no heart sounds and no carotid pulse after 1 min. Pupils fixed and dilated. Time of death 21:58.
Age: 104.0
Sex: M
Vaccine: COVID19
Symptoms: Abdominal pain, Abdominal pain upper, Infection
Clinical narrative: Narrative:  hx HTN, hypothyroidism, BPH, CKD, hx rectal CA s/p chemoXRT/resection (1989) presenting with 3 days of constant, non- radiating epigastric/periumbilical pain. Admitted with breakthrough infection.