chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 62.0
Sex: M
Vaccine: COVID19-2
Symptoms: Hepatitis viral test, Hypertension, Hypertensive urgency, Hypervolaemia, Hypoxia
Clinical narrative: Patient is a 63 y.o. male patient of MD with history of CKD stage 3b, HTN, IDDM2 presented to Medical Center with abnormal renal labs. Hospital course complicated by COVID-19 pneumonia and worsening AKI on CKD.      AKI on CKD stage 4 with ATN Metabolic acidosis - resolved Anemia of CKD - stable Cr 3.85 on admission (baseline 2.5-2.6), now 4.67 Recently established care with Nephrology, Dr. 7/2023 renal USG w/o obstruction, indicative of medical renal disease IFE, hepatitis, HIV, ANA & complements -ve Nephrology consulted: s/p renal bx 09/21: DM nephropathy, HTN nephrosclerosis, ATN S/P IV lasix prn per Nephro recs - given 9/25, stopped further doses, ok for discharge, IPR denied Plan for to discharge home with HHS likely next am after Eliquis pre-auth complete     New onset RUE DVTs USG w/ complete occlusive acute DVT R radial v, partially occlusive acute DVT R ulnar v Was on heparin gtt, transitioned to DOAC 10/03, continue on discharge x3 mon ID preauthorization over the phone yesterday, Eliquis was approved Prescription was sent to his pharmacy, case management to verify coverage   HTN urgency : resolved BP 210s/90s on admission Currently well controlled with 5 mg Norvasc and 100 mg Toprol Continue the same, outpatient follow-up with PCP Adjust as needed Elevated troponin 2/2 demand ischemia in assoc w/ AKI on CKD Trop 88>97  EKG w/o acute coronary change Denies chest pain Continue statin, BB   Acute hypoxemic respiratory failure - Resolved COVID-19 Suspected CAP CXR B/L airspace opacities R>L edema vs infectious COVID +ve 9/8 BNP 10.6K in renal failure--diuresed w/ Bumex initially 2/2 fluid overload, COVID, and suspected CAP Pulm consulted, treated empirically with Levaquin PRN bronchodilators Initially hypoxic, req up to 4 L NC 09/19, dced IVFs, CXR w/ improvement, duoneb PRN, weaned to RA 09/20    COVID-19 COVID-19 +ve 9/8 Reports vaccination CXR R>L infiltrate 9/8 Finished course of Remdesivir/Decadron   T2DM on insulin 8/2023 A1c 7.4% Metformin held, renal decline likely precludes further use at DC Adjusted home insulin dose based on inpatient dosing Close follow-up with PCP, adjust as needed  Anemia of ESRD Baseline HGB ~9 Hgb 6.6 on 9/11 - transfused pRBC x 1 Venofer, Epo ordered per renal Hgb 9/30 stable  and stopped daily labs   Anal fistula F/w CRS, Dr Was scheduled for op intervention 9/7 Not cleared due to AKI Reschedule for later date as OP
Age: 62.0
Sex: M
Vaccine: COVID19-2
Symptoms: Lung infiltration, Lung opacity, Metabolic acidosis, Myocardial ischaemia, Nephrogenic anaemia
Clinical narrative: Patient is a 63 y.o. male patient of MD with history of CKD stage 3b, HTN, IDDM2 presented to Medical Center with abnormal renal labs. Hospital course complicated by COVID-19 pneumonia and worsening AKI on CKD.      AKI on CKD stage 4 with ATN Metabolic acidosis - resolved Anemia of CKD - stable Cr 3.85 on admission (baseline 2.5-2.6), now 4.67 Recently established care with Nephrology, Dr. 7/2023 renal USG w/o obstruction, indicative of medical renal disease IFE, hepatitis, HIV, ANA & complements -ve Nephrology consulted: s/p renal bx 09/21: DM nephropathy, HTN nephrosclerosis, ATN S/P IV lasix prn per Nephro recs - given 9/25, stopped further doses, ok for discharge, IPR denied Plan for to discharge home with HHS likely next am after Eliquis pre-auth complete     New onset RUE DVTs USG w/ complete occlusive acute DVT R radial v, partially occlusive acute DVT R ulnar v Was on heparin gtt, transitioned to DOAC 10/03, continue on discharge x3 mon ID preauthorization over the phone yesterday, Eliquis was approved Prescription was sent to his pharmacy, case management to verify coverage   HTN urgency : resolved BP 210s/90s on admission Currently well controlled with 5 mg Norvasc and 100 mg Toprol Continue the same, outpatient follow-up with PCP Adjust as needed Elevated troponin 2/2 demand ischemia in assoc w/ AKI on CKD Trop 88>97  EKG w/o acute coronary change Denies chest pain Continue statin, BB   Acute hypoxemic respiratory failure - Resolved COVID-19 Suspected CAP CXR B/L airspace opacities R>L edema vs infectious COVID +ve 9/8 BNP 10.6K in renal failure--diuresed w/ Bumex initially 2/2 fluid overload, COVID, and suspected CAP Pulm consulted, treated empirically with Levaquin PRN bronchodilators Initially hypoxic, req up to 4 L NC 09/19, dced IVFs, CXR w/ improvement, duoneb PRN, weaned to RA 09/20    COVID-19 COVID-19 +ve 9/8 Reports vaccination CXR R>L infiltrate 9/8 Finished course of Remdesivir/Decadron   T2DM on insulin 8/2023 A1c 7.4% Metformin held, renal decline likely precludes further use at DC Adjusted home insulin dose based on inpatient dosing Close follow-up with PCP, adjust as needed  Anemia of ESRD Baseline HGB ~9 Hgb 6.6 on 9/11 - transfused pRBC x 1 Venofer, Epo ordered per renal Hgb 9/30 stable  and stopped daily labs   Anal fistula F/w CRS, Dr Was scheduled for op intervention 9/7 Not cleared due to AKI Reschedule for later date as OP
Age: 62.0
Sex: M
Vaccine: COVID19-2
Symptoms: Nephrosclerosis, Peripheral vein occlusion, Pneumonia, Pulmonary oedema, Red blood cell transfusion
Clinical narrative: Patient is a 63 y.o. male patient of MD with history of CKD stage 3b, HTN, IDDM2 presented to Medical Center with abnormal renal labs. Hospital course complicated by COVID-19 pneumonia and worsening AKI on CKD.      AKI on CKD stage 4 with ATN Metabolic acidosis - resolved Anemia of CKD - stable Cr 3.85 on admission (baseline 2.5-2.6), now 4.67 Recently established care with Nephrology, Dr. 7/2023 renal USG w/o obstruction, indicative of medical renal disease IFE, hepatitis, HIV, ANA & complements -ve Nephrology consulted: s/p renal bx 09/21: DM nephropathy, HTN nephrosclerosis, ATN S/P IV lasix prn per Nephro recs - given 9/25, stopped further doses, ok for discharge, IPR denied Plan for to discharge home with HHS likely next am after Eliquis pre-auth complete     New onset RUE DVTs USG w/ complete occlusive acute DVT R radial v, partially occlusive acute DVT R ulnar v Was on heparin gtt, transitioned to DOAC 10/03, continue on discharge x3 mon ID preauthorization over the phone yesterday, Eliquis was approved Prescription was sent to his pharmacy, case management to verify coverage   HTN urgency : resolved BP 210s/90s on admission Currently well controlled with 5 mg Norvasc and 100 mg Toprol Continue the same, outpatient follow-up with PCP Adjust as needed Elevated troponin 2/2 demand ischemia in assoc w/ AKI on CKD Trop 88>97  EKG w/o acute coronary change Denies chest pain Continue statin, BB   Acute hypoxemic respiratory failure - Resolved COVID-19 Suspected CAP CXR B/L airspace opacities R>L edema vs infectious COVID +ve 9/8 BNP 10.6K in renal failure--diuresed w/ Bumex initially 2/2 fluid overload, COVID, and suspected CAP Pulm consulted, treated empirically with Levaquin PRN bronchodilators Initially hypoxic, req up to 4 L NC 09/19, dced IVFs, CXR w/ improvement, duoneb PRN, weaned to RA 09/20    COVID-19 COVID-19 +ve 9/8 Reports vaccination CXR R>L infiltrate 9/8 Finished course of Remdesivir/Decadron   T2DM on insulin 8/2023 A1c 7.4% Metformin held, renal decline likely precludes further use at DC Adjusted home insulin dose based on inpatient dosing Close follow-up with PCP, adjust as needed  Anemia of ESRD Baseline HGB ~9 Hgb 6.6 on 9/11 - transfused pRBC x 1 Venofer, Epo ordered per renal Hgb 9/30 stable  and stopped daily labs   Anal fistula F/w CRS, Dr Was scheduled for op intervention 9/7 Not cleared due to AKI Reschedule for later date as OP
Age: 62.0
Sex: M
Vaccine: COVID19-2
Symptoms: Renal failure, Renal function test abnormal, Renal impairment, Renal tubular necrosis, SARS-CoV-2 test positive
Clinical narrative: Patient is a 63 y.o. male patient of MD with history of CKD stage 3b, HTN, IDDM2 presented to Medical Center with abnormal renal labs. Hospital course complicated by COVID-19 pneumonia and worsening AKI on CKD.      AKI on CKD stage 4 with ATN Metabolic acidosis - resolved Anemia of CKD - stable Cr 3.85 on admission (baseline 2.5-2.6), now 4.67 Recently established care with Nephrology, Dr. 7/2023 renal USG w/o obstruction, indicative of medical renal disease IFE, hepatitis, HIV, ANA & complements -ve Nephrology consulted: s/p renal bx 09/21: DM nephropathy, HTN nephrosclerosis, ATN S/P IV lasix prn per Nephro recs - given 9/25, stopped further doses, ok for discharge, IPR denied Plan for to discharge home with HHS likely next am after Eliquis pre-auth complete     New onset RUE DVTs USG w/ complete occlusive acute DVT R radial v, partially occlusive acute DVT R ulnar v Was on heparin gtt, transitioned to DOAC 10/03, continue on discharge x3 mon ID preauthorization over the phone yesterday, Eliquis was approved Prescription was sent to his pharmacy, case management to verify coverage   HTN urgency : resolved BP 210s/90s on admission Currently well controlled with 5 mg Norvasc and 100 mg Toprol Continue the same, outpatient follow-up with PCP Adjust as needed Elevated troponin 2/2 demand ischemia in assoc w/ AKI on CKD Trop 88>97  EKG w/o acute coronary change Denies chest pain Continue statin, BB   Acute hypoxemic respiratory failure - Resolved COVID-19 Suspected CAP CXR B/L airspace opacities R>L edema vs infectious COVID +ve 9/8 BNP 10.6K in renal failure--diuresed w/ Bumex initially 2/2 fluid overload, COVID, and suspected CAP Pulm consulted, treated empirically with Levaquin PRN bronchodilators Initially hypoxic, req up to 4 L NC 09/19, dced IVFs, CXR w/ improvement, duoneb PRN, weaned to RA 09/20    COVID-19 COVID-19 +ve 9/8 Reports vaccination CXR R>L infiltrate 9/8 Finished course of Remdesivir/Decadron   T2DM on insulin 8/2023 A1c 7.4% Metformin held, renal decline likely precludes further use at DC Adjusted home insulin dose based on inpatient dosing Close follow-up with PCP, adjust as needed  Anemia of ESRD Baseline HGB ~9 Hgb 6.6 on 9/11 - transfused pRBC x 1 Venofer, Epo ordered per renal Hgb 9/30 stable  and stopped daily labs   Anal fistula F/w CRS, Dr Was scheduled for op intervention 9/7 Not cleared due to AKI Reschedule for later date as OP
Age: 62.0
Sex: M
Vaccine: COVID19-2
Symptoms: Troponin increased, Ultrasound Doppler abnormal, Ultrasound kidney
Clinical narrative: Patient is a 63 y.o. male patient of MD with history of CKD stage 3b, HTN, IDDM2 presented to Medical Center with abnormal renal labs. Hospital course complicated by COVID-19 pneumonia and worsening AKI on CKD.      AKI on CKD stage 4 with ATN Metabolic acidosis - resolved Anemia of CKD - stable Cr 3.85 on admission (baseline 2.5-2.6), now 4.67 Recently established care with Nephrology, Dr. 7/2023 renal USG w/o obstruction, indicative of medical renal disease IFE, hepatitis, HIV, ANA & complements -ve Nephrology consulted: s/p renal bx 09/21: DM nephropathy, HTN nephrosclerosis, ATN S/P IV lasix prn per Nephro recs - given 9/25, stopped further doses, ok for discharge, IPR denied Plan for to discharge home with HHS likely next am after Eliquis pre-auth complete     New onset RUE DVTs USG w/ complete occlusive acute DVT R radial v, partially occlusive acute DVT R ulnar v Was on heparin gtt, transitioned to DOAC 10/03, continue on discharge x3 mon ID preauthorization over the phone yesterday, Eliquis was approved Prescription was sent to his pharmacy, case management to verify coverage   HTN urgency : resolved BP 210s/90s on admission Currently well controlled with 5 mg Norvasc and 100 mg Toprol Continue the same, outpatient follow-up with PCP Adjust as needed Elevated troponin 2/2 demand ischemia in assoc w/ AKI on CKD Trop 88>97  EKG w/o acute coronary change Denies chest pain Continue statin, BB   Acute hypoxemic respiratory failure - Resolved COVID-19 Suspected CAP CXR B/L airspace opacities R>L edema vs infectious COVID +ve 9/8 BNP 10.6K in renal failure--diuresed w/ Bumex initially 2/2 fluid overload, COVID, and suspected CAP Pulm consulted, treated empirically with Levaquin PRN bronchodilators Initially hypoxic, req up to 4 L NC 09/19, dced IVFs, CXR w/ improvement, duoneb PRN, weaned to RA 09/20    COVID-19 COVID-19 +ve 9/8 Reports vaccination CXR R>L infiltrate 9/8 Finished course of Remdesivir/Decadron   T2DM on insulin 8/2023 A1c 7.4% Metformin held, renal decline likely precludes further use at DC Adjusted home insulin dose based on inpatient dosing Close follow-up with PCP, adjust as needed  Anemia of ESRD Baseline HGB ~9 Hgb 6.6 on 9/11 - transfused pRBC x 1 Venofer, Epo ordered per renal Hgb 9/30 stable  and stopped daily labs   Anal fistula F/w CRS, Dr Was scheduled for op intervention 9/7 Not cleared due to AKI Reschedule for later date as OP
Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Asthenia, Chest X-ray, Confusional state, Dyskinesia, Hypotonia
Clinical narrative: PERSON AWOKE AT 2:00 AM ON 11/11/2023 THRASHING, INCONTINENT, WEAK AND CONFUSION. PATIENT EXPERIENCING ATONIA IN BILATERAL LOWER EXTREMITIES. PERSON WAS TRANSPORTED TO THE  ER FOR EVALUATION VIA AMBULANCE (UNSURE ON TIME). PERSON WAS TESTED IN THE ER THEN ADMITTED TO THE MED-SURG FLOOR FOR OBSERVATION FROM SYMPTOMATIC VACCINE REACTION. PERSON WAS OBSERVED AT THE HOSPITAL AND DISCHARGED ON 11/12/2023 WITH NORMAL FINDINGS. PERSON HAS DOCTORS APPOINTMENT FOR FOLLOW-UP FROM ER VISIT AND HOSPITAL ADMISSION ON 11/15/2023. PERSON TO CONITUE MONITORING SYMPTOMS AT HOME.
Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Immunisation reaction, Incontinence, Laboratory test, SARS-CoV-2 test, Sleep disorder
Clinical narrative: PERSON AWOKE AT 2:00 AM ON 11/11/2023 THRASHING, INCONTINENT, WEAK AND CONFUSION. PATIENT EXPERIENCING ATONIA IN BILATERAL LOWER EXTREMITIES. PERSON WAS TRANSPORTED TO THE  ER FOR EVALUATION VIA AMBULANCE (UNSURE ON TIME). PERSON WAS TESTED IN THE ER THEN ADMITTED TO THE MED-SURG FLOOR FOR OBSERVATION FROM SYMPTOMATIC VACCINE REACTION. PERSON WAS OBSERVED AT THE HOSPITAL AND DISCHARGED ON 11/12/2023 WITH NORMAL FINDINGS. PERSON HAS DOCTORS APPOINTMENT FOR FOLLOW-UP FROM ER VISIT AND HOSPITAL ADMISSION ON 11/15/2023. PERSON TO CONITUE MONITORING SYMPTOMS AT HOME.
Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Urine analysis
Clinical narrative: PERSON AWOKE AT 2:00 AM ON 11/11/2023 THRASHING, INCONTINENT, WEAK AND CONFUSION. PATIENT EXPERIENCING ATONIA IN BILATERAL LOWER EXTREMITIES. PERSON WAS TRANSPORTED TO THE  ER FOR EVALUATION VIA AMBULANCE (UNSURE ON TIME). PERSON WAS TESTED IN THE ER THEN ADMITTED TO THE MED-SURG FLOOR FOR OBSERVATION FROM SYMPTOMATIC VACCINE REACTION. PERSON WAS OBSERVED AT THE HOSPITAL AND DISCHARGED ON 11/12/2023 WITH NORMAL FINDINGS. PERSON HAS DOCTORS APPOINTMENT FOR FOLLOW-UP FROM ER VISIT AND HOSPITAL ADMISSION ON 11/15/2023. PERSON TO CONITUE MONITORING SYMPTOMS AT HOME.
Age: 68.0
Sex: F
Vaccine: COVID19
Symptoms: Mental status changes
Clinical narrative: Patient began experiencing altered mental status, required admission to hospital. Overnight patient returned to baseline with no treatment.
Age: 80.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute kidney injury, Acute respiratory failure, Blood creatinine, Blood culture negative, COVID-19
Clinical narrative: Patient is a 81 y.o. female with a history of HTN and HLD who presented to hospital 10/4/2023 with chest pain and tachycardia concerning for atrial fibrillation. Found to have COVID requiring low flow O2.    1. Chest pain: Suspect MSK given tenderness on exam. Troponin 26, 22. EKG on admit without ST changes. Suspected demand from tachycardia and AKI. Echo EF 60%. Pleurtic chest pain. No further workup necessary.  2. Elevated troponin: Suspect demand ischemia in setting of tachycardia, COVID, acute respiratory failure. In setting of AKI. EKG without ST changes.    3. COVID-19: Symptom onset 9/28/2023 with COVID+ swab 10/4/23. Did require O2 on admit. Initiated Decadron. Continue pulmonary hygiene. Assess LFTs for Remdesevir candidacy. Wean O2. Stopped decadron as off O2.  4. Acute Hypoxic Respiratory Failure: Presented with tachypnea and desaturations in ED. Not on home O2. Improved with 2L NC. May be related to above. Wean O2 as able. Added albuterol for wheezing. Resolved.  5. Severe sepsis: Suspect related to above. Presented with HR 115, RR 20 and AKI. S/p IVF with improvement. Has improved off abx, will continue to hold and monitor closely. BC negative, procalcitonin WNL.  6. Tachycardia: Suspect from above. Initially thought afib RVR. EP evaluated, no afib concerns at this time. S/p heparin gtt. Monitor on telemetry.  7. AKI: Baseline Cr 0.9?1. Cr on admission 1.49. Likely prerenal given history. S/p IVF with improvement. Resolved.  8. HTN: Per history. Home medications resumed with hold parameters. Monitor and titrate as indicated.
Age: 80.0
Sex: F
Vaccine: COVID19-2
Symptoms: Cardiac telemetry, Chest pain, Echocardiogram normal, Ejection fraction normal, Electrocardiogram normal
Clinical narrative: Patient is a 81 y.o. female with a history of HTN and HLD who presented to hospital 10/4/2023 with chest pain and tachycardia concerning for atrial fibrillation. Found to have COVID requiring low flow O2.    1. Chest pain: Suspect MSK given tenderness on exam. Troponin 26, 22. EKG on admit without ST changes. Suspected demand from tachycardia and AKI. Echo EF 60%. Pleurtic chest pain. No further workup necessary.  2. Elevated troponin: Suspect demand ischemia in setting of tachycardia, COVID, acute respiratory failure. In setting of AKI. EKG without ST changes.    3. COVID-19: Symptom onset 9/28/2023 with COVID+ swab 10/4/23. Did require O2 on admit. Initiated Decadron. Continue pulmonary hygiene. Assess LFTs for Remdesevir candidacy. Wean O2. Stopped decadron as off O2.  4. Acute Hypoxic Respiratory Failure: Presented with tachypnea and desaturations in ED. Not on home O2. Improved with 2L NC. May be related to above. Wean O2 as able. Added albuterol for wheezing. Resolved.  5. Severe sepsis: Suspect related to above. Presented with HR 115, RR 20 and AKI. S/p IVF with improvement. Has improved off abx, will continue to hold and monitor closely. BC negative, procalcitonin WNL.  6. Tachycardia: Suspect from above. Initially thought afib RVR. EP evaluated, no afib concerns at this time. S/p heparin gtt. Monitor on telemetry.  7. AKI: Baseline Cr 0.9?1. Cr on admission 1.49. Likely prerenal given history. S/p IVF with improvement. Resolved.  8. HTN: Per history. Home medications resumed with hold parameters. Monitor and titrate as indicated.
Age: 80.0
Sex: F
Vaccine: COVID19-2
Symptoms: Liver function test, Myocardial ischaemia, Oxygen saturation decreased, Pleuritic pain, Procalcitonin normal
Clinical narrative: Patient is a 81 y.o. female with a history of HTN and HLD who presented to hospital 10/4/2023 with chest pain and tachycardia concerning for atrial fibrillation. Found to have COVID requiring low flow O2.    1. Chest pain: Suspect MSK given tenderness on exam. Troponin 26, 22. EKG on admit without ST changes. Suspected demand from tachycardia and AKI. Echo EF 60%. Pleurtic chest pain. No further workup necessary.  2. Elevated troponin: Suspect demand ischemia in setting of tachycardia, COVID, acute respiratory failure. In setting of AKI. EKG without ST changes.    3. COVID-19: Symptom onset 9/28/2023 with COVID+ swab 10/4/23. Did require O2 on admit. Initiated Decadron. Continue pulmonary hygiene. Assess LFTs for Remdesevir candidacy. Wean O2. Stopped decadron as off O2.  4. Acute Hypoxic Respiratory Failure: Presented with tachypnea and desaturations in ED. Not on home O2. Improved with 2L NC. May be related to above. Wean O2 as able. Added albuterol for wheezing. Resolved.  5. Severe sepsis: Suspect related to above. Presented with HR 115, RR 20 and AKI. S/p IVF with improvement. Has improved off abx, will continue to hold and monitor closely. BC negative, procalcitonin WNL.  6. Tachycardia: Suspect from above. Initially thought afib RVR. EP evaluated, no afib concerns at this time. S/p heparin gtt. Monitor on telemetry.  7. AKI: Baseline Cr 0.9?1. Cr on admission 1.49. Likely prerenal given history. S/p IVF with improvement. Resolved.  8. HTN: Per history. Home medications resumed with hold parameters. Monitor and titrate as indicated.
Age: 80.0
Sex: F
Vaccine: COVID19-2
Symptoms: SARS-CoV-2 test positive, Sepsis, Tachycardia, Tachypnoea, Tenderness
Clinical narrative: Patient is a 81 y.o. female with a history of HTN and HLD who presented to hospital 10/4/2023 with chest pain and tachycardia concerning for atrial fibrillation. Found to have COVID requiring low flow O2.    1. Chest pain: Suspect MSK given tenderness on exam. Troponin 26, 22. EKG on admit without ST changes. Suspected demand from tachycardia and AKI. Echo EF 60%. Pleurtic chest pain. No further workup necessary.  2. Elevated troponin: Suspect demand ischemia in setting of tachycardia, COVID, acute respiratory failure. In setting of AKI. EKG without ST changes.    3. COVID-19: Symptom onset 9/28/2023 with COVID+ swab 10/4/23. Did require O2 on admit. Initiated Decadron. Continue pulmonary hygiene. Assess LFTs for Remdesevir candidacy. Wean O2. Stopped decadron as off O2.  4. Acute Hypoxic Respiratory Failure: Presented with tachypnea and desaturations in ED. Not on home O2. Improved with 2L NC. May be related to above. Wean O2 as able. Added albuterol for wheezing. Resolved.  5. Severe sepsis: Suspect related to above. Presented with HR 115, RR 20 and AKI. S/p IVF with improvement. Has improved off abx, will continue to hold and monitor closely. BC negative, procalcitonin WNL.  6. Tachycardia: Suspect from above. Initially thought afib RVR. EP evaluated, no afib concerns at this time. S/p heparin gtt. Monitor on telemetry.  7. AKI: Baseline Cr 0.9?1. Cr on admission 1.49. Likely prerenal given history. S/p IVF with improvement. Resolved.  8. HTN: Per history. Home medications resumed with hold parameters. Monitor and titrate as indicated.
Age: 80.0
Sex: F
Vaccine: COVID19-2
Symptoms: Troponin increased, Wheezing
Clinical narrative: Patient is a 81 y.o. female with a history of HTN and HLD who presented to hospital 10/4/2023 with chest pain and tachycardia concerning for atrial fibrillation. Found to have COVID requiring low flow O2.    1. Chest pain: Suspect MSK given tenderness on exam. Troponin 26, 22. EKG on admit without ST changes. Suspected demand from tachycardia and AKI. Echo EF 60%. Pleurtic chest pain. No further workup necessary.  2. Elevated troponin: Suspect demand ischemia in setting of tachycardia, COVID, acute respiratory failure. In setting of AKI. EKG without ST changes.    3. COVID-19: Symptom onset 9/28/2023 with COVID+ swab 10/4/23. Did require O2 on admit. Initiated Decadron. Continue pulmonary hygiene. Assess LFTs for Remdesevir candidacy. Wean O2. Stopped decadron as off O2.  4. Acute Hypoxic Respiratory Failure: Presented with tachypnea and desaturations in ED. Not on home O2. Improved with 2L NC. May be related to above. Wean O2 as able. Added albuterol for wheezing. Resolved.  5. Severe sepsis: Suspect related to above. Presented with HR 115, RR 20 and AKI. S/p IVF with improvement. Has improved off abx, will continue to hold and monitor closely. BC negative, procalcitonin WNL.  6. Tachycardia: Suspect from above. Initially thought afib RVR. EP evaluated, no afib concerns at this time. S/p heparin gtt. Monitor on telemetry.  7. AKI: Baseline Cr 0.9?1. Cr on admission 1.49. Likely prerenal given history. S/p IVF with improvement. Resolved.  8. HTN: Per history. Home medications resumed with hold parameters. Monitor and titrate as indicated.
Age: 64.0
Sex: F
Vaccine: FLU4
Symptoms: Arthralgia, Burning sensation, Contusion, Haemorrhage, Immediate post-injection reaction
Clinical narrative: Immediate burning with small amount of bleeding and bruising, severe shoulder pain radiating down into hand (pinky and ring finger).   On day 5 and is still having issues.
Age: 64.0
Sex: F
Vaccine: FLU4
Symptoms: Pain, Pain in extremity
Clinical narrative: Immediate burning with small amount of bleeding and bruising, severe shoulder pain radiating down into hand (pinky and ring finger).   On day 5 and is still having issues.
Age: 5.0
Sex: M
Vaccine: DTAPIPV, DTAPIPV, MMRV
Symptoms: Expired product administered
Clinical narrative: KINRIX- LOT # 2KL4K- EXPIRED 11/9/23.  PT DID NOT DISPLAY ANY SIGNS OR SYMPTOMS OF DISTRESS AFTER RECEIVING THE VACCINATION.  PT WAS RE-VACCINATED WITH KINRIX PER GUIDELINES DURING SAME OFFICE VISIT.
Age: 57.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Blood culture negative, COVID-19, Chest X-ray normal, Chronic obstructive pulmonary disease
Clinical narrative: Patient is a 58 y.o. female patient of DO with history of COPD, hypertension, hyperlipidemia, hypothyroidism, diabetes presented to Hospital with shortness of breath.   COPD with acute exacerbation  Acute hypoxemic respiratory failure  Started on Solu-Medrol 40 every 8 IV, will discontinue and transition to  IV Dexamethasone - course completed IV Rocephin stopped 10/8/23- discharge home on  Azithromycin 500 mg oral daily x 5 days Albuterol inhaler Discontinue IV fluids Pain management Blood cultures negative Sputum culture- not collected Wean Oxygen as tolerated- currently 98% on room air   Leukocytosis- chronic Likely reactive to steroids WBC- 23.2->16.02>18.82>20.42 Afebrile   Covid-19 Virus Infection Date of onset of symptoms: 10/3/2023 Symptoms present on admission: Yes Date of covid positive test: 10/5/2023 Vaccination status: vaccinated 1 dose Imaging: Chest x-ray unremarkable  Oxygen requirements on admission: 2 L Current oxygen requirements: room air Medical therapy: steroids Remdesivir  Consultants following: ID Anticipated special isolation end date: 10/15/2023 Encourage prone position as tolerated   DISCHARGE SUMMARY    Admitted: 10/5/2023 Discharge Date: 10/12/23    PCP Handoff    Recommended Outpatient Testing: none   Results Pending At Discharge: none     Clinical Summary   Patient is a 58 y.o. female patient of DO with history of COPD, hypertension, hyperlipidemia, hypothyroidism, diabetes presented to Hospital with shortness of breath.   COPD with acute exacerbation  Acute hypoxemic respiratory failure  Started on Solu-Medrol 40 every 8 IV, will discontinue and transition to  IV Dexamethasone - course completed IV Rocephin stopped 10/8/23- discharge home on  Azithromycin 500 mg oral daily x 5 days Albuterol inhaler Discontinue IV fluids Pain management Blood cultures negative Sputum culture- not collected Wean Oxygen as tolerated- currently 98% on room air   Leukocytosis- chronic Likely reactive to steroids WBC- 23.2->16.02>18.82>20.42 Afebrile   Covid-19 Virus Infection Date of onset of symptoms: 10/3/2023 Symptoms present on admission: Yes Date of covid positive test: 10/5/2023 Vaccination status: vaccinated 1 dose Imaging: Chest x-ray unremarkable  Oxygen requirements on admission: 2 L Current oxygen requirements: room air Medical therapy: steroids Remdesivir  Consultants following: ID Anticipated special isolation end date: 10/15/2023 Encourage prone position as tolerated   Type 2 diabetes uncontrolled Last A1c 5.7 I will hold insulin 70/30 24 twice a day Start Lantus 20 units at bedtime, Humalog 8 units every meal plus sliding scale Hold Trulicity in the hospital Start Januvia 100 mg once daily instead Hold metformin   Hypertension Continue losartan Hold Lasix- continue at discharge   Hypothyroidism Continue levothyroxine   GERD Continue Protonix   Hyperlipidemia Continue Zetia   Neuropathy Continue gabapentin   Nicotine use disorder  Advised smoking cessation  Start nicotine patch
Age: 57.0
Sex: F
Vaccine: COVID19-2
Symptoms: Condition aggravated, Diabetes mellitus inadequate control, Dyspnoea, Glycosylated haemoglobin, Insulin therapy
Clinical narrative: Patient is a 58 y.o. female patient of DO with history of COPD, hypertension, hyperlipidemia, hypothyroidism, diabetes presented to Hospital with shortness of breath.   COPD with acute exacerbation  Acute hypoxemic respiratory failure  Started on Solu-Medrol 40 every 8 IV, will discontinue and transition to  IV Dexamethasone - course completed IV Rocephin stopped 10/8/23- discharge home on  Azithromycin 500 mg oral daily x 5 days Albuterol inhaler Discontinue IV fluids Pain management Blood cultures negative Sputum culture- not collected Wean Oxygen as tolerated- currently 98% on room air   Leukocytosis- chronic Likely reactive to steroids WBC- 23.2->16.02>18.82>20.42 Afebrile   Covid-19 Virus Infection Date of onset of symptoms: 10/3/2023 Symptoms present on admission: Yes Date of covid positive test: 10/5/2023 Vaccination status: vaccinated 1 dose Imaging: Chest x-ray unremarkable  Oxygen requirements on admission: 2 L Current oxygen requirements: room air Medical therapy: steroids Remdesivir  Consultants following: ID Anticipated special isolation end date: 10/15/2023 Encourage prone position as tolerated   DISCHARGE SUMMARY    Admitted: 10/5/2023 Discharge Date: 10/12/23    PCP Handoff    Recommended Outpatient Testing: none   Results Pending At Discharge: none     Clinical Summary   Patient is a 58 y.o. female patient of DO with history of COPD, hypertension, hyperlipidemia, hypothyroidism, diabetes presented to Hospital with shortness of breath.   COPD with acute exacerbation  Acute hypoxemic respiratory failure  Started on Solu-Medrol 40 every 8 IV, will discontinue and transition to  IV Dexamethasone - course completed IV Rocephin stopped 10/8/23- discharge home on  Azithromycin 500 mg oral daily x 5 days Albuterol inhaler Discontinue IV fluids Pain management Blood cultures negative Sputum culture- not collected Wean Oxygen as tolerated- currently 98% on room air   Leukocytosis- chronic Likely reactive to steroids WBC- 23.2->16.02>18.82>20.42 Afebrile   Covid-19 Virus Infection Date of onset of symptoms: 10/3/2023 Symptoms present on admission: Yes Date of covid positive test: 10/5/2023 Vaccination status: vaccinated 1 dose Imaging: Chest x-ray unremarkable  Oxygen requirements on admission: 2 L Current oxygen requirements: room air Medical therapy: steroids Remdesivir  Consultants following: ID Anticipated special isolation end date: 10/15/2023 Encourage prone position as tolerated   Type 2 diabetes uncontrolled Last A1c 5.7 I will hold insulin 70/30 24 twice a day Start Lantus 20 units at bedtime, Humalog 8 units every meal plus sliding scale Hold Trulicity in the hospital Start Januvia 100 mg once daily instead Hold metformin   Hypertension Continue losartan Hold Lasix- continue at discharge   Hypothyroidism Continue levothyroxine   GERD Continue Protonix   Hyperlipidemia Continue Zetia   Neuropathy Continue gabapentin   Nicotine use disorder  Advised smoking cessation  Start nicotine patch
Age: 57.0
Sex: F
Vaccine: COVID19-2
Symptoms: Leukocytosis, SARS-CoV-2 test positive, White blood cell count increased
Clinical narrative: Patient is a 58 y.o. female patient of DO with history of COPD, hypertension, hyperlipidemia, hypothyroidism, diabetes presented to Hospital with shortness of breath.   COPD with acute exacerbation  Acute hypoxemic respiratory failure  Started on Solu-Medrol 40 every 8 IV, will discontinue and transition to  IV Dexamethasone - course completed IV Rocephin stopped 10/8/23- discharge home on  Azithromycin 500 mg oral daily x 5 days Albuterol inhaler Discontinue IV fluids Pain management Blood cultures negative Sputum culture- not collected Wean Oxygen as tolerated- currently 98% on room air   Leukocytosis- chronic Likely reactive to steroids WBC- 23.2->16.02>18.82>20.42 Afebrile   Covid-19 Virus Infection Date of onset of symptoms: 10/3/2023 Symptoms present on admission: Yes Date of covid positive test: 10/5/2023 Vaccination status: vaccinated 1 dose Imaging: Chest x-ray unremarkable  Oxygen requirements on admission: 2 L Current oxygen requirements: room air Medical therapy: steroids Remdesivir  Consultants following: ID Anticipated special isolation end date: 10/15/2023 Encourage prone position as tolerated   DISCHARGE SUMMARY    Admitted: 10/5/2023 Discharge Date: 10/12/23    PCP Handoff    Recommended Outpatient Testing: none   Results Pending At Discharge: none     Clinical Summary   Patient is a 58 y.o. female patient of DO with history of COPD, hypertension, hyperlipidemia, hypothyroidism, diabetes presented to Hospital with shortness of breath.   COPD with acute exacerbation  Acute hypoxemic respiratory failure  Started on Solu-Medrol 40 every 8 IV, will discontinue and transition to  IV Dexamethasone - course completed IV Rocephin stopped 10/8/23- discharge home on  Azithromycin 500 mg oral daily x 5 days Albuterol inhaler Discontinue IV fluids Pain management Blood cultures negative Sputum culture- not collected Wean Oxygen as tolerated- currently 98% on room air   Leukocytosis- chronic Likely reactive to steroids WBC- 23.2->16.02>18.82>20.42 Afebrile   Covid-19 Virus Infection Date of onset of symptoms: 10/3/2023 Symptoms present on admission: Yes Date of covid positive test: 10/5/2023 Vaccination status: vaccinated 1 dose Imaging: Chest x-ray unremarkable  Oxygen requirements on admission: 2 L Current oxygen requirements: room air Medical therapy: steroids Remdesivir  Consultants following: ID Anticipated special isolation end date: 10/15/2023 Encourage prone position as tolerated   Type 2 diabetes uncontrolled Last A1c 5.7 I will hold insulin 70/30 24 twice a day Start Lantus 20 units at bedtime, Humalog 8 units every meal plus sliding scale Hold Trulicity in the hospital Start Januvia 100 mg once daily instead Hold metformin   Hypertension Continue losartan Hold Lasix- continue at discharge   Hypothyroidism Continue levothyroxine   GERD Continue Protonix   Hyperlipidemia Continue Zetia   Neuropathy Continue gabapentin   Nicotine use disorder  Advised smoking cessation  Start nicotine patch
Age: 45.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Agitation, Angiogram pulmonary abnormal, Anxiety, Bronchoalveolar lavage normal
Clinical narrative: 46 y.o. male patient of, MD with history of TBI, depression. Presents with SOB, productive cough.   Acute Hypoxic Respiratory Failure, hypoxic COVID 19 Pneumonia Rule out pulmonary tuberculosis Symptoms present on admission: productive cough, SOB Pfizer COVID vaccine 1/27/2023 Date of covid positive test: 9/21/2023 Out of isolation 10/2 WBC 21k  CTPA:  New diffuse reticulonodular infiltrates, New patchy opacity anteriorly in the right upper lobe and mild patchy right lower lobe opacities  Quantiferon MTB indeterminate, Sputum for AFB x 3 negative  S/P Bronchoscopy 10/2, BAL preliminary negative for TB, final will take 6-8 weeks.   Oxygen requirements on admission 5-6L Current oxygen requirements: RA  s/p paxlovid, s/p CTX and azithro in ED  Completed dexamethasone, remdesivir Pulmonology following  - ok to discharge and out of isolation    Leukocytosis Possible 2/2 steroids Monitor    Hx of TBI Follows with Dr.   Summer of 2022 Residual LUE pain and spacticity, dysarthria NARxCheck 9/29 Continue gabapentin  Cont home baclofen  Neurogenic Bladder D/t TBI  Continue bethanechol   Agitation - Improved Depression Psych consulted-Continue Celexa 20mg qday.Add Atarax 25mg tid prn anxiety.Continue PRN Geodon for agitation Scheduled Atarax 9/29 Continue home Celexa   Tobacco Use Cessation discussed by Agency NRT PRN
Age: 45.0
Sex: M
Vaccine: COVID19
Symptoms: Bronchoscopy, COVID-19 pneumonia, Condition aggravated, Depression, Dyspnoea
Clinical narrative: 46 y.o. male patient of, MD with history of TBI, depression. Presents with SOB, productive cough.   Acute Hypoxic Respiratory Failure, hypoxic COVID 19 Pneumonia Rule out pulmonary tuberculosis Symptoms present on admission: productive cough, SOB Pfizer COVID vaccine 1/27/2023 Date of covid positive test: 9/21/2023 Out of isolation 10/2 WBC 21k  CTPA:  New diffuse reticulonodular infiltrates, New patchy opacity anteriorly in the right upper lobe and mild patchy right lower lobe opacities  Quantiferon MTB indeterminate, Sputum for AFB x 3 negative  S/P Bronchoscopy 10/2, BAL preliminary negative for TB, final will take 6-8 weeks.   Oxygen requirements on admission 5-6L Current oxygen requirements: RA  s/p paxlovid, s/p CTX and azithro in ED  Completed dexamethasone, remdesivir Pulmonology following  - ok to discharge and out of isolation    Leukocytosis Possible 2/2 steroids Monitor    Hx of TBI Follows with Dr.   Summer of 2022 Residual LUE pain and spacticity, dysarthria NARxCheck 9/29 Continue gabapentin  Cont home baclofen  Neurogenic Bladder D/t TBI  Continue bethanechol   Agitation - Improved Depression Psych consulted-Continue Celexa 20mg qday.Add Atarax 25mg tid prn anxiety.Continue PRN Geodon for agitation Scheduled Atarax 9/29 Continue home Celexa   Tobacco Use Cessation discussed by Agency NRT PRN
Age: 45.0
Sex: M
Vaccine: COVID19
Symptoms: Hypoxia, Leukocytosis, Lung infiltration, Lung opacity, Mycobacterium test negative
Clinical narrative: 46 y.o. male patient of, MD with history of TBI, depression. Presents with SOB, productive cough.   Acute Hypoxic Respiratory Failure, hypoxic COVID 19 Pneumonia Rule out pulmonary tuberculosis Symptoms present on admission: productive cough, SOB Pfizer COVID vaccine 1/27/2023 Date of covid positive test: 9/21/2023 Out of isolation 10/2 WBC 21k  CTPA:  New diffuse reticulonodular infiltrates, New patchy opacity anteriorly in the right upper lobe and mild patchy right lower lobe opacities  Quantiferon MTB indeterminate, Sputum for AFB x 3 negative  S/P Bronchoscopy 10/2, BAL preliminary negative for TB, final will take 6-8 weeks.   Oxygen requirements on admission 5-6L Current oxygen requirements: RA  s/p paxlovid, s/p CTX and azithro in ED  Completed dexamethasone, remdesivir Pulmonology following  - ok to discharge and out of isolation    Leukocytosis Possible 2/2 steroids Monitor    Hx of TBI Follows with Dr.   Summer of 2022 Residual LUE pain and spacticity, dysarthria NARxCheck 9/29 Continue gabapentin  Cont home baclofen  Neurogenic Bladder D/t TBI  Continue bethanechol   Agitation - Improved Depression Psych consulted-Continue Celexa 20mg qday.Add Atarax 25mg tid prn anxiety.Continue PRN Geodon for agitation Scheduled Atarax 9/29 Continue home Celexa   Tobacco Use Cessation discussed by Agency NRT PRN
Age: 45.0
Sex: M
Vaccine: COVID19
Symptoms: Neurogenic bladder, Productive cough, SARS-CoV-2 test positive, Sputum culture, White blood cell count increased
Clinical narrative: 46 y.o. male patient of, MD with history of TBI, depression. Presents with SOB, productive cough.   Acute Hypoxic Respiratory Failure, hypoxic COVID 19 Pneumonia Rule out pulmonary tuberculosis Symptoms present on admission: productive cough, SOB Pfizer COVID vaccine 1/27/2023 Date of covid positive test: 9/21/2023 Out of isolation 10/2 WBC 21k  CTPA:  New diffuse reticulonodular infiltrates, New patchy opacity anteriorly in the right upper lobe and mild patchy right lower lobe opacities  Quantiferon MTB indeterminate, Sputum for AFB x 3 negative  S/P Bronchoscopy 10/2, BAL preliminary negative for TB, final will take 6-8 weeks.   Oxygen requirements on admission 5-6L Current oxygen requirements: RA  s/p paxlovid, s/p CTX and azithro in ED  Completed dexamethasone, remdesivir Pulmonology following  - ok to discharge and out of isolation    Leukocytosis Possible 2/2 steroids Monitor    Hx of TBI Follows with Dr.   Summer of 2022 Residual LUE pain and spacticity, dysarthria NARxCheck 9/29 Continue gabapentin  Cont home baclofen  Neurogenic Bladder D/t TBI  Continue bethanechol   Agitation - Improved Depression Psych consulted-Continue Celexa 20mg qday.Add Atarax 25mg tid prn anxiety.Continue PRN Geodon for agitation Scheduled Atarax 9/29 Continue home Celexa   Tobacco Use Cessation discussed by Agency NRT PRN
Age: 85.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Asthenia, Atelectasis, Atrial fibrillation, COVID-19
Clinical narrative: Patient is an 87-year-old woman with a history of scleroderma who lives with her son, who was diagnosed with COVID; the patient is now presenting during evening hours of 10/6/2023 with increasing shortness of breath and lethargy, also tested positive for COVID. She was started on Decadron and Remdesivir, and improved slowly, saturating well on RA, tolerating diet, stable for discharge home today.   COVID pneumonitis Acute hypoxic respiratory failure- resolved - Presented with: Shortness of breath, weakness - Symptom onset: 48 hours prior to arrival increasing in a crescendo fashion - Positive COVID-19: 10/6/2023 at RMH - Vaccination status: Pfizer, x3 in 2021 - CXR on admission showed mild atelectasis - Oxygen status: initially required 2L/min, now on RA - Decadron: Yes. Expected end date 10/16/2023; holding patient's home methylprednisolone until finishing Decadron - Remdesivir: Yes. Received until 10/10 - DVT prophylaxis: Heparin   Paroxysmal Atrial fibrillation - Seen in atrial fibrillation clinic December 2021 and managing conservatively with rate control, although rates have been stable and no need for meds - Not on AC due to history of bleeding risk, on aspirin   Scleroderma  - Known hx of w/ limited cutaneous SSc reported & CREST symptoms identified - Home regimen: hydroxychloroquine/methylprednisolone for immunosuppressive tx; holding plaquenil d/t interaction with remdesivir, holding methylpred with current decadron - resume at discharge - No PAH noted on TTE (10/2017) w/ outpt follow up per Rheum   HFpEF - Abnormal diastolic filling noted TTE (10/2017) w/o evidence of acute HF present - Underlying scleroderma and HTN the reported etiology   Protein calorie malnutrition GERD - BMI 16 w/ diffuse muscle wasting and increased fatigue reported - Continue to encourage PO intake and supplements  - Continue Pepcid   Essential hypertension - Known hx w/ component of scleroderma and BP controlled - Continue amlodipine with hold parameters   Recurrent major depressive disorder, in partial remission - Known hx w/o symptoms of geriatric depression identified - Continue sertraline @ this time and review for continued need for medical tx by PCP recommended   Hyperlipidemia - Continue simvastatin Fibromuscular dysplasia - Bilateral status post brachial artery bypass grafting with bilateral digital ischemia - Fall precautions notably when using an assist device   Adult failure to thrive syndrome - Chronic impaired mobility d/t multi-joint OA, MSK contractures and scleroderma changes - PT/OT recommends ECF, but patient and family opting to go home with HHS
Age: 85.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Chest X-ray abnormal, Drug interaction, Dyspnoea, Fatigue
Clinical narrative: Patient is an 87-year-old woman with a history of scleroderma who lives with her son, who was diagnosed with COVID; the patient is now presenting during evening hours of 10/6/2023 with increasing shortness of breath and lethargy, also tested positive for COVID. She was started on Decadron and Remdesivir, and improved slowly, saturating well on RA, tolerating diet, stable for discharge home today.   COVID pneumonitis Acute hypoxic respiratory failure- resolved - Presented with: Shortness of breath, weakness - Symptom onset: 48 hours prior to arrival increasing in a crescendo fashion - Positive COVID-19: 10/6/2023 at RMH - Vaccination status: Pfizer, x3 in 2021 - CXR on admission showed mild atelectasis - Oxygen status: initially required 2L/min, now on RA - Decadron: Yes. Expected end date 10/16/2023; holding patient's home methylprednisolone until finishing Decadron - Remdesivir: Yes. Received until 10/10 - DVT prophylaxis: Heparin   Paroxysmal Atrial fibrillation - Seen in atrial fibrillation clinic December 2021 and managing conservatively with rate control, although rates have been stable and no need for meds - Not on AC due to history of bleeding risk, on aspirin   Scleroderma  - Known hx of w/ limited cutaneous SSc reported & CREST symptoms identified - Home regimen: hydroxychloroquine/methylprednisolone for immunosuppressive tx; holding plaquenil d/t interaction with remdesivir, holding methylpred with current decadron - resume at discharge - No PAH noted on TTE (10/2017) w/ outpt follow up per Rheum   HFpEF - Abnormal diastolic filling noted TTE (10/2017) w/o evidence of acute HF present - Underlying scleroderma and HTN the reported etiology   Protein calorie malnutrition GERD - BMI 16 w/ diffuse muscle wasting and increased fatigue reported - Continue to encourage PO intake and supplements  - Continue Pepcid   Essential hypertension - Known hx w/ component of scleroderma and BP controlled - Continue amlodipine with hold parameters   Recurrent major depressive disorder, in partial remission - Known hx w/o symptoms of geriatric depression identified - Continue sertraline @ this time and review for continued need for medical tx by PCP recommended   Hyperlipidemia - Continue simvastatin Fibromuscular dysplasia - Bilateral status post brachial artery bypass grafting with bilateral digital ischemia - Fall precautions notably when using an assist device   Adult failure to thrive syndrome - Chronic impaired mobility d/t multi-joint OA, MSK contractures and scleroderma changes - PT/OT recommends ECF, but patient and family opting to go home with HHS
Age: 85.0
Sex: F
Vaccine: COVID19
Symptoms: Lethargy, Muscle atrophy, SARS-CoV-2 test positive
Clinical narrative: Patient is an 87-year-old woman with a history of scleroderma who lives with her son, who was diagnosed with COVID; the patient is now presenting during evening hours of 10/6/2023 with increasing shortness of breath and lethargy, also tested positive for COVID. She was started on Decadron and Remdesivir, and improved slowly, saturating well on RA, tolerating diet, stable for discharge home today.   COVID pneumonitis Acute hypoxic respiratory failure- resolved - Presented with: Shortness of breath, weakness - Symptom onset: 48 hours prior to arrival increasing in a crescendo fashion - Positive COVID-19: 10/6/2023 at RMH - Vaccination status: Pfizer, x3 in 2021 - CXR on admission showed mild atelectasis - Oxygen status: initially required 2L/min, now on RA - Decadron: Yes. Expected end date 10/16/2023; holding patient's home methylprednisolone until finishing Decadron - Remdesivir: Yes. Received until 10/10 - DVT prophylaxis: Heparin   Paroxysmal Atrial fibrillation - Seen in atrial fibrillation clinic December 2021 and managing conservatively with rate control, although rates have been stable and no need for meds - Not on AC due to history of bleeding risk, on aspirin   Scleroderma  - Known hx of w/ limited cutaneous SSc reported & CREST symptoms identified - Home regimen: hydroxychloroquine/methylprednisolone for immunosuppressive tx; holding plaquenil d/t interaction with remdesivir, holding methylpred with current decadron - resume at discharge - No PAH noted on TTE (10/2017) w/ outpt follow up per Rheum   HFpEF - Abnormal diastolic filling noted TTE (10/2017) w/o evidence of acute HF present - Underlying scleroderma and HTN the reported etiology   Protein calorie malnutrition GERD - BMI 16 w/ diffuse muscle wasting and increased fatigue reported - Continue to encourage PO intake and supplements  - Continue Pepcid   Essential hypertension - Known hx w/ component of scleroderma and BP controlled - Continue amlodipine with hold parameters   Recurrent major depressive disorder, in partial remission - Known hx w/o symptoms of geriatric depression identified - Continue sertraline @ this time and review for continued need for medical tx by PCP recommended   Hyperlipidemia - Continue simvastatin Fibromuscular dysplasia - Bilateral status post brachial artery bypass grafting with bilateral digital ischemia - Fall precautions notably when using an assist device   Adult failure to thrive syndrome - Chronic impaired mobility d/t multi-joint OA, MSK contractures and scleroderma changes - PT/OT recommends ECF, but patient and family opting to go home with HHS
Age: 1.42
Sex: M
Vaccine: COVID19
Symptoms: Incorrect dose administered, Product preparation error
Clinical narrative: Staff member gave the whole contents of vial without diluting it to patient.
Age: 40.0
Sex: M
Vaccine: SMALLMNK
Symptoms: Extra dose administered
Clinical narrative: Patient told provider he never received vaccination. Patient did receive vaccination year prior. Medication error occurred. Provider and patient notified. No issues at this time and no treatment needed at this time.
Age: 87.0
Sex: F
Vaccine: COVID19
Symptoms: Presyncope
Clinical narrative: Resident had a pre-syncopal episode. Was sent to the ER, returned home the same day at baseline with medication changes.