"Notes"	"VAERS ID"	"VAERS ID Code"	"Symptoms"	"Symptoms Code"	"Age"	"Age Code"	Adverse Event Description
	"0914604-1"	"0914604-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Spouse awoke 12/20 and found spouse dead. Client was not transferred to hospital."
	"0914895-1"	"0914895-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Injection given on 12/28/20 - no adverse events and no issues yesterday; Death today, 12/30/20, approx.. 2am today  (unknown if related - Administrator marked as natural causes)"
	"0926600-1"	"0926600-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient did not report any signs or symptoms of adverse reaction to vaccine. Patient suffered from several comorbidities  (diabetes and renal insufficiency). Patient reported not feeling well 01/06/2021 and passed away that day."
	"0926600-1"	"0926600-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Patient did not report any signs or symptoms of adverse reaction to vaccine. Patient suffered from several comorbidities  (diabetes and renal insufficiency). Patient reported not feeling well 01/06/2021 and passed away that day."
	"0928513-1"	"0928513-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Resident passed away in her sleep"
	"0937434-1"	"0937434-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt expired due to possible cardiac arrest.  Unsure if this was vaccine related."
	"0943362-1"	"0943362-1"	"AUTOPSY"	"10050117"	"65-79 years"	"65-79"	"Pt collapsed at home approx 5:30 pm and died"
	"0943362-1"	"0943362-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt collapsed at home approx 5:30 pm and died"
	"0943362-1"	"0943362-1"	"SYNCOPE"	"10042772"	"65-79 years"	"65-79"	"Pt collapsed at home approx 5:30 pm and died"
	"0948164-1"	"0948164-1"	"ABDOMINAL PAIN"	"10000081"	"65-79 years"	"65-79"	"Abdominal pain, Headaches, chest pain, loss of appetite, confusion, elevated liver enzymes 1/8-1/15/21"
	"0948164-1"	"0948164-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	"Abdominal pain, Headaches, chest pain, loss of appetite, confusion, elevated liver enzymes 1/8-1/15/21"
	"0948164-1"	"0948164-1"	"CHEST X-RAY"	"10008498"	"65-79 years"	"65-79"	"Abdominal pain, Headaches, chest pain, loss of appetite, confusion, elevated liver enzymes 1/8-1/15/21"
	"0948164-1"	"0948164-1"	"COMPUTERISED TOMOGRAM"	"10010234"	"65-79 years"	"65-79"	"Abdominal pain, Headaches, chest pain, loss of appetite, confusion, elevated liver enzymes 1/8-1/15/21"
	"0948164-1"	"0948164-1"	"COMPUTERISED TOMOGRAM ABDOMEN"	"10053876"	"65-79 years"	"65-79"	"Abdominal pain, Headaches, chest pain, loss of appetite, confusion, elevated liver enzymes 1/8-1/15/21"
	"0948164-1"	"0948164-1"	"CONFUSIONAL STATE"	"10010305"	"65-79 years"	"65-79"	"Abdominal pain, Headaches, chest pain, loss of appetite, confusion, elevated liver enzymes 1/8-1/15/21"
	"0948164-1"	"0948164-1"	"DECREASED APPETITE"	"10061428"	"65-79 years"	"65-79"	"Abdominal pain, Headaches, chest pain, loss of appetite, confusion, elevated liver enzymes 1/8-1/15/21"
	"0948164-1"	"0948164-1"	"FULL BLOOD COUNT"	"10017411"	"65-79 years"	"65-79"	"Abdominal pain, Headaches, chest pain, loss of appetite, confusion, elevated liver enzymes 1/8-1/15/21"
	"0948164-1"	"0948164-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	"Abdominal pain, Headaches, chest pain, loss of appetite, confusion, elevated liver enzymes 1/8-1/15/21"
	"0948164-1"	"0948164-1"	"HEPATIC ENZYME INCREASED"	"10060795"	"65-79 years"	"65-79"	"Abdominal pain, Headaches, chest pain, loss of appetite, confusion, elevated liver enzymes 1/8-1/15/21"
	"0948164-1"	"0948164-1"	"METABOLIC FUNCTION TEST"	"10062191"	"65-79 years"	"65-79"	"Abdominal pain, Headaches, chest pain, loss of appetite, confusion, elevated liver enzymes 1/8-1/15/21"
	"0951519-1"	"0951519-1"	"PALPITATIONS"	"10033557"	"65-79 years"	"65-79"	"Narrative: Symptoms: Palpitations & Syncope Treatment: EPINEPHRINE 1 MG ONCE ,EPINEPHRINE 1 MG ONCE ,SODIUM BICARBONATE 50 ML ONCE"
	"0951519-1"	"0951519-1"	"SYNCOPE"	"10042772"	"65-79 years"	"65-79"	"Narrative: Symptoms: Palpitations & Syncope Treatment: EPINEPHRINE 1 MG ONCE ,EPINEPHRINE 1 MG ONCE ,SODIUM BICARBONATE 50 ML ONCE"
	"0965831-1"	"0965831-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received her first dose of vaccine on Monday, January 18th.  Two days later on Wednesday, January 18th, she retired to bed early.  Later that night when her husband went to bed, he found her in the bed deceased.  No other details of the event are know."
	"0979837-1"	"0979837-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Per EMS, the patient was last seen walking and talking to wife 10 minutes prior to EMS arrival. EMS reports via patients wife, that patient was upstairs to change for his doctor appointment then patient's wife found him down. The patient received his COVID-19 vaccine on 1/25/21. EMS states they gave 5 rounds of EPI then patient moved into vfib then was shocked once but returned to asystole. In ED, the patient initially in asystole CPR was started immediately. The patient was given 3 rounds EPI, 1 round bicarb. The patient stayed in PEA throughout. Patient was given tPA. Patient continued to be in asystole and time of death was called at 11:35 am."
	"0979837-1"	"0979837-1"	"CARDIOVERSION"	"10007661"	"65-79 years"	"65-79"	"Per EMS, the patient was last seen walking and talking to wife 10 minutes prior to EMS arrival. EMS reports via patients wife, that patient was upstairs to change for his doctor appointment then patient's wife found him down. The patient received his COVID-19 vaccine on 1/25/21. EMS states they gave 5 rounds of EPI then patient moved into vfib then was shocked once but returned to asystole. In ED, the patient initially in asystole CPR was started immediately. The patient was given 3 rounds EPI, 1 round bicarb. The patient stayed in PEA throughout. Patient was given tPA. Patient continued to be in asystole and time of death was called at 11:35 am."
	"0979837-1"	"0979837-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Per EMS, the patient was last seen walking and talking to wife 10 minutes prior to EMS arrival. EMS reports via patients wife, that patient was upstairs to change for his doctor appointment then patient's wife found him down. The patient received his COVID-19 vaccine on 1/25/21. EMS states they gave 5 rounds of EPI then patient moved into vfib then was shocked once but returned to asystole. In ED, the patient initially in asystole CPR was started immediately. The patient was given 3 rounds EPI, 1 round bicarb. The patient stayed in PEA throughout. Patient was given tPA. Patient continued to be in asystole and time of death was called at 11:35 am."
	"0979837-1"	"0979837-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	"Per EMS, the patient was last seen walking and talking to wife 10 minutes prior to EMS arrival. EMS reports via patients wife, that patient was upstairs to change for his doctor appointment then patient's wife found him down. The patient received his COVID-19 vaccine on 1/25/21. EMS states they gave 5 rounds of EPI then patient moved into vfib then was shocked once but returned to asystole. In ED, the patient initially in asystole CPR was started immediately. The patient was given 3 rounds EPI, 1 round bicarb. The patient stayed in PEA throughout. Patient was given tPA. Patient continued to be in asystole and time of death was called at 11:35 am."
	"0979837-1"	"0979837-1"	"PRESYNCOPE"	"10036653"	"65-79 years"	"65-79"	"Per EMS, the patient was last seen walking and talking to wife 10 minutes prior to EMS arrival. EMS reports via patients wife, that patient was upstairs to change for his doctor appointment then patient's wife found him down. The patient received his COVID-19 vaccine on 1/25/21. EMS states they gave 5 rounds of EPI then patient moved into vfib then was shocked once but returned to asystole. In ED, the patient initially in asystole CPR was started immediately. The patient was given 3 rounds EPI, 1 round bicarb. The patient stayed in PEA throughout. Patient was given tPA. Patient continued to be in asystole and time of death was called at 11:35 am."
	"0979837-1"	"0979837-1"	"PULSELESS ELECTRICAL ACTIVITY"	"10058151"	"65-79 years"	"65-79"	"Per EMS, the patient was last seen walking and talking to wife 10 minutes prior to EMS arrival. EMS reports via patients wife, that patient was upstairs to change for his doctor appointment then patient's wife found him down. The patient received his COVID-19 vaccine on 1/25/21. EMS states they gave 5 rounds of EPI then patient moved into vfib then was shocked once but returned to asystole. In ED, the patient initially in asystole CPR was started immediately. The patient was given 3 rounds EPI, 1 round bicarb. The patient stayed in PEA throughout. Patient was given tPA. Patient continued to be in asystole and time of death was called at 11:35 am."
	"0979837-1"	"0979837-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Per EMS, the patient was last seen walking and talking to wife 10 minutes prior to EMS arrival. EMS reports via patients wife, that patient was upstairs to change for his doctor appointment then patient's wife found him down. The patient received his COVID-19 vaccine on 1/25/21. EMS states they gave 5 rounds of EPI then patient moved into vfib then was shocked once but returned to asystole. In ED, the patient initially in asystole CPR was started immediately. The patient was given 3 rounds EPI, 1 round bicarb. The patient stayed in PEA throughout. Patient was given tPA. Patient continued to be in asystole and time of death was called at 11:35 am."
	"0979837-1"	"0979837-1"	"VENTRICULAR FIBRILLATION"	"10047290"	"65-79 years"	"65-79"	"Per EMS, the patient was last seen walking and talking to wife 10 minutes prior to EMS arrival. EMS reports via patients wife, that patient was upstairs to change for his doctor appointment then patient's wife found him down. The patient received his COVID-19 vaccine on 1/25/21. EMS states they gave 5 rounds of EPI then patient moved into vfib then was shocked once but returned to asystole. In ED, the patient initially in asystole CPR was started immediately. The patient was given 3 rounds EPI, 1 round bicarb. The patient stayed in PEA throughout. Patient was given tPA. Patient continued to be in asystole and time of death was called at 11:35 am."
	"0982890-1"	"0982890-1"	"BRADYCARDIA"	"10006093"	"65-79 years"	"65-79"	"Pt presented to ER via EMS at 1556  3 days after receiving vaccine. pt was breathing approximately 50 times a minutes and o2 sats in the 70's upon arrival. NP decided to intubate, Rocuronium and Versed given. Pt became bradycardic and 1 amp of Atropine was given without improvement. No pulse felt, CPR started per ACLS protocol. 7 Epi's given. Time of death- 1632. After TOD pt was swabbed for COVID-19 and the results were positive."
	"0982890-1"	"0982890-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt presented to ER via EMS at 1556  3 days after receiving vaccine. pt was breathing approximately 50 times a minutes and o2 sats in the 70's upon arrival. NP decided to intubate, Rocuronium and Versed given. Pt became bradycardic and 1 amp of Atropine was given without improvement. No pulse felt, CPR started per ACLS protocol. 7 Epi's given. Time of death- 1632. After TOD pt was swabbed for COVID-19 and the results were positive."
	"0982890-1"	"0982890-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Pt presented to ER via EMS at 1556  3 days after receiving vaccine. pt was breathing approximately 50 times a minutes and o2 sats in the 70's upon arrival. NP decided to intubate, Rocuronium and Versed given. Pt became bradycardic and 1 amp of Atropine was given without improvement. No pulse felt, CPR started per ACLS protocol. 7 Epi's given. Time of death- 1632. After TOD pt was swabbed for COVID-19 and the results were positive."
	"0982890-1"	"0982890-1"	"PULSE ABSENT"	"10037469"	"65-79 years"	"65-79"	"Pt presented to ER via EMS at 1556  3 days after receiving vaccine. pt was breathing approximately 50 times a minutes and o2 sats in the 70's upon arrival. NP decided to intubate, Rocuronium and Versed given. Pt became bradycardic and 1 amp of Atropine was given without improvement. No pulse felt, CPR started per ACLS protocol. 7 Epi's given. Time of death- 1632. After TOD pt was swabbed for COVID-19 and the results were positive."
	"0982890-1"	"0982890-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Pt presented to ER via EMS at 1556  3 days after receiving vaccine. pt was breathing approximately 50 times a minutes and o2 sats in the 70's upon arrival. NP decided to intubate, Rocuronium and Versed given. Pt became bradycardic and 1 amp of Atropine was given without improvement. No pulse felt, CPR started per ACLS protocol. 7 Epi's given. Time of death- 1632. After TOD pt was swabbed for COVID-19 and the results were positive."
	"0982890-1"	"0982890-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Pt presented to ER via EMS at 1556  3 days after receiving vaccine. pt was breathing approximately 50 times a minutes and o2 sats in the 70's upon arrival. NP decided to intubate, Rocuronium and Versed given. Pt became bradycardic and 1 amp of Atropine was given without improvement. No pulse felt, CPR started per ACLS protocol. 7 Epi's given. Time of death- 1632. After TOD pt was swabbed for COVID-19 and the results were positive."
	"0982890-1"	"0982890-1"	"TROPONIN INCREASED"	"10058267"	"65-79 years"	"65-79"	"Pt presented to ER via EMS at 1556  3 days after receiving vaccine. pt was breathing approximately 50 times a minutes and o2 sats in the 70's upon arrival. NP decided to intubate, Rocuronium and Versed given. Pt became bradycardic and 1 amp of Atropine was given without improvement. No pulse felt, CPR started per ACLS protocol. 7 Epi's given. Time of death- 1632. After TOD pt was swabbed for COVID-19 and the results were positive."
	"0982890-1"	"0982890-1"	"WHITE BLOOD CELL COUNT INCREASED"	"10047943"	"65-79 years"	"65-79"	"Pt presented to ER via EMS at 1556  3 days after receiving vaccine. pt was breathing approximately 50 times a minutes and o2 sats in the 70's upon arrival. NP decided to intubate, Rocuronium and Versed given. Pt became bradycardic and 1 amp of Atropine was given without improvement. No pulse felt, CPR started per ACLS protocol. 7 Epi's given. Time of death- 1632. After TOD pt was swabbed for COVID-19 and the results were positive."
	"0983428-1"	"0983428-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"ANAEMIA"	"10002034"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"AORTIC STENOSIS"	"10002906"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"ATELECTASIS"	"10003598"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"ATRIOVENTRICULAR BLOCK COMPLETE"	"10003673"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"BLOOD CREATININE INCREASED"	"10005483"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"BLOOD POTASSIUM DECREASED"	"10005724"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"BLOOD PRESSURE FLUCTUATION"	"10005746"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"BLOOD SODIUM DECREASED"	"10005802"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"BLOOD UREA INCREASED"	"10005851"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"C-REACTIVE PROTEIN INCREASED"	"10006825"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"CARDIOMEGALY"	"10007632"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"DEHYDRATION"	"10012174"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"HAEMOGLOBIN DECREASED"	"10018884"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"HYPERTENSION"	"10020772"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"LUNG INFILTRATION"	"10025102"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"PROCALCITONIN INCREASED"	"10067081"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"SEPSIS"	"10040047"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"STAPHYLOCOCCAL BACTERAEMIA"	"10051017"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0983428-1"	"0983428-1"	"WHITE BLOOD CELL COUNT INCREASED"	"10047943"	"65-79 years"	"65-79"	"Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia."
	"0990780-1"	"0990780-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"patient passed"
	"0991997-1"	"0991997-1"	"BLOOD GLUCOSE INCREASED"	"10005557"	"65-79 years"	"65-79"	"Resident c/o nausea evening of 1/29 (nausea common for her post dialysis), had a large emesis at approx 2220, 0030 (unusual for resident to vomit)- received Zofran per order.   Skin cool and damp, Blood sugar 147 (checked due to h/o diabetes and poor intake).  At approx 230am Blood pressured checked and noted to be 52/29.   Resident transferred to ER, intubated and transferred to higher level of care where she passed away on 1/30 at 736pm.     Resident's medical notes indicated likely shock, cardiogenic in nature, sepsis (source unknown) along with a multitude of other co-morbidities that resident has."
	"0991997-1"	"0991997-1"	"BLOOD POTASSIUM INCREASED"	"10005725"	"65-79 years"	"65-79"	"Resident c/o nausea evening of 1/29 (nausea common for her post dialysis), had a large emesis at approx 2220, 0030 (unusual for resident to vomit)- received Zofran per order.   Skin cool and damp, Blood sugar 147 (checked due to h/o diabetes and poor intake).  At approx 230am Blood pressured checked and noted to be 52/29.   Resident transferred to ER, intubated and transferred to higher level of care where she passed away on 1/30 at 736pm.     Resident's medical notes indicated likely shock, cardiogenic in nature, sepsis (source unknown) along with a multitude of other co-morbidities that resident has."
	"0991997-1"	"0991997-1"	"CARDIOGENIC SHOCK"	"10007625"	"65-79 years"	"65-79"	"Resident c/o nausea evening of 1/29 (nausea common for her post dialysis), had a large emesis at approx 2220, 0030 (unusual for resident to vomit)- received Zofran per order.   Skin cool and damp, Blood sugar 147 (checked due to h/o diabetes and poor intake).  At approx 230am Blood pressured checked and noted to be 52/29.   Resident transferred to ER, intubated and transferred to higher level of care where she passed away on 1/30 at 736pm.     Resident's medical notes indicated likely shock, cardiogenic in nature, sepsis (source unknown) along with a multitude of other co-morbidities that resident has."
	"0991997-1"	"0991997-1"	"COLD SWEAT"	"10009866"	"65-79 years"	"65-79"	"Resident c/o nausea evening of 1/29 (nausea common for her post dialysis), had a large emesis at approx 2220, 0030 (unusual for resident to vomit)- received Zofran per order.   Skin cool and damp, Blood sugar 147 (checked due to h/o diabetes and poor intake).  At approx 230am Blood pressured checked and noted to be 52/29.   Resident transferred to ER, intubated and transferred to higher level of care where she passed away on 1/30 at 736pm.     Resident's medical notes indicated likely shock, cardiogenic in nature, sepsis (source unknown) along with a multitude of other co-morbidities that resident has."
	"0991997-1"	"0991997-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Resident c/o nausea evening of 1/29 (nausea common for her post dialysis), had a large emesis at approx 2220, 0030 (unusual for resident to vomit)- received Zofran per order.   Skin cool and damp, Blood sugar 147 (checked due to h/o diabetes and poor intake).  At approx 230am Blood pressured checked and noted to be 52/29.   Resident transferred to ER, intubated and transferred to higher level of care where she passed away on 1/30 at 736pm.     Resident's medical notes indicated likely shock, cardiogenic in nature, sepsis (source unknown) along with a multitude of other co-morbidities that resident has."
	"0991997-1"	"0991997-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Resident c/o nausea evening of 1/29 (nausea common for her post dialysis), had a large emesis at approx 2220, 0030 (unusual for resident to vomit)- received Zofran per order.   Skin cool and damp, Blood sugar 147 (checked due to h/o diabetes and poor intake).  At approx 230am Blood pressured checked and noted to be 52/29.   Resident transferred to ER, intubated and transferred to higher level of care where she passed away on 1/30 at 736pm.     Resident's medical notes indicated likely shock, cardiogenic in nature, sepsis (source unknown) along with a multitude of other co-morbidities that resident has."
	"0991997-1"	"0991997-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"Resident c/o nausea evening of 1/29 (nausea common for her post dialysis), had a large emesis at approx 2220, 0030 (unusual for resident to vomit)- received Zofran per order.   Skin cool and damp, Blood sugar 147 (checked due to h/o diabetes and poor intake).  At approx 230am Blood pressured checked and noted to be 52/29.   Resident transferred to ER, intubated and transferred to higher level of care where she passed away on 1/30 at 736pm.     Resident's medical notes indicated likely shock, cardiogenic in nature, sepsis (source unknown) along with a multitude of other co-morbidities that resident has."
	"0991997-1"	"0991997-1"	"SEPSIS"	"10040047"	"65-79 years"	"65-79"	"Resident c/o nausea evening of 1/29 (nausea common for her post dialysis), had a large emesis at approx 2220, 0030 (unusual for resident to vomit)- received Zofran per order.   Skin cool and damp, Blood sugar 147 (checked due to h/o diabetes and poor intake).  At approx 230am Blood pressured checked and noted to be 52/29.   Resident transferred to ER, intubated and transferred to higher level of care where she passed away on 1/30 at 736pm.     Resident's medical notes indicated likely shock, cardiogenic in nature, sepsis (source unknown) along with a multitude of other co-morbidities that resident has."
	"0991997-1"	"0991997-1"	"TROPONIN INCREASED"	"10058267"	"65-79 years"	"65-79"	"Resident c/o nausea evening of 1/29 (nausea common for her post dialysis), had a large emesis at approx 2220, 0030 (unusual for resident to vomit)- received Zofran per order.   Skin cool and damp, Blood sugar 147 (checked due to h/o diabetes and poor intake).  At approx 230am Blood pressured checked and noted to be 52/29.   Resident transferred to ER, intubated and transferred to higher level of care where she passed away on 1/30 at 736pm.     Resident's medical notes indicated likely shock, cardiogenic in nature, sepsis (source unknown) along with a multitude of other co-morbidities that resident has."
	"0991997-1"	"0991997-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"Resident c/o nausea evening of 1/29 (nausea common for her post dialysis), had a large emesis at approx 2220, 0030 (unusual for resident to vomit)- received Zofran per order.   Skin cool and damp, Blood sugar 147 (checked due to h/o diabetes and poor intake).  At approx 230am Blood pressured checked and noted to be 52/29.   Resident transferred to ER, intubated and transferred to higher level of care where she passed away on 1/30 at 736pm.     Resident's medical notes indicated likely shock, cardiogenic in nature, sepsis (source unknown) along with a multitude of other co-morbidities that resident has."
	"0991997-1"	"0991997-1"	"WHITE BLOOD CELL COUNT INCREASED"	"10047943"	"65-79 years"	"65-79"	"Resident c/o nausea evening of 1/29 (nausea common for her post dialysis), had a large emesis at approx 2220, 0030 (unusual for resident to vomit)- received Zofran per order.   Skin cool and damp, Blood sugar 147 (checked due to h/o diabetes and poor intake).  At approx 230am Blood pressured checked and noted to be 52/29.   Resident transferred to ER, intubated and transferred to higher level of care where she passed away on 1/30 at 736pm.     Resident's medical notes indicated likely shock, cardiogenic in nature, sepsis (source unknown) along with a multitude of other co-morbidities that resident has."
	"0992238-1"	"0992238-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Tested positive for COVID19 on 12-30-2020, Admitted to Hospital on 1/5/2021 with active COVID, Patient died 1/29/2021."
	"0992238-1"	"0992238-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Tested positive for COVID19 on 12-30-2020, Admitted to Hospital on 1/5/2021 with active COVID, Patient died 1/29/2021."
	"0992238-1"	"0992238-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Tested positive for COVID19 on 12-30-2020, Admitted to Hospital on 1/5/2021 with active COVID, Patient died 1/29/2021."
	"0998228-1"	"0998228-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"Found unresponsive"
	"1002229-1"	"1002229-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"spontaneous death, found  unresponsive in cell after normal morning activities"
	"1002229-1"	"1002229-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"spontaneous death, found  unresponsive in cell after normal morning activities"
	"1017129-1"	"1017129-1"	"AUTOPSY"	"10050117"	"65-79 years"	"65-79"	"Sudden cardiac death.  Autopsy report: right coronary artery thrombosis."
	"1017129-1"	"1017129-1"	"CORONARY ARTERY THROMBOSIS"	"10011091"	"65-79 years"	"65-79"	"Sudden cardiac death.  Autopsy report: right coronary artery thrombosis."
	"1017129-1"	"1017129-1"	"SUDDEN CARDIAC DEATH"	"10049418"	"65-79 years"	"65-79"	"Sudden cardiac death.  Autopsy report: right coronary artery thrombosis."
	"1017176-1"	"1017176-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"Patient had Covid-19 in October of 2020. He recovered. He received the vaccination on 12/30/2020 with no complaints. On 01-05-2021 it was noted to he was incontinent of urine and bilateral lower extremity edema. Lab work was completed showed acute kidney injury. He had decreased blood pressure and oxygen saturations on 01-06-2021 He was admitted to the hospital with rapid progression of symptoms and suggested multi-system failure. He had a long cardiac history. On 01-14-2021 he passed away with a diagnosis of Cardiomyopathic CHF, A.Fib contributory."
	"1017176-1"	"1017176-1"	"ATRIAL FIBRILLATION"	"10003658"	"65-79 years"	"65-79"	"Patient had Covid-19 in October of 2020. He recovered. He received the vaccination on 12/30/2020 with no complaints. On 01-05-2021 it was noted to he was incontinent of urine and bilateral lower extremity edema. Lab work was completed showed acute kidney injury. He had decreased blood pressure and oxygen saturations on 01-06-2021 He was admitted to the hospital with rapid progression of symptoms and suggested multi-system failure. He had a long cardiac history. On 01-14-2021 he passed away with a diagnosis of Cardiomyopathic CHF, A.Fib contributory."
	"1017176-1"	"1017176-1"	"BLOOD PRESSURE DECREASED"	"10005734"	"65-79 years"	"65-79"	"Patient had Covid-19 in October of 2020. He recovered. He received the vaccination on 12/30/2020 with no complaints. On 01-05-2021 it was noted to he was incontinent of urine and bilateral lower extremity edema. Lab work was completed showed acute kidney injury. He had decreased blood pressure and oxygen saturations on 01-06-2021 He was admitted to the hospital with rapid progression of symptoms and suggested multi-system failure. He had a long cardiac history. On 01-14-2021 he passed away with a diagnosis of Cardiomyopathic CHF, A.Fib contributory."
	"1017176-1"	"1017176-1"	"CARDIAC FAILURE CONGESTIVE"	"10007559"	"65-79 years"	"65-79"	"Patient had Covid-19 in October of 2020. He recovered. He received the vaccination on 12/30/2020 with no complaints. On 01-05-2021 it was noted to he was incontinent of urine and bilateral lower extremity edema. Lab work was completed showed acute kidney injury. He had decreased blood pressure and oxygen saturations on 01-06-2021 He was admitted to the hospital with rapid progression of symptoms and suggested multi-system failure. He had a long cardiac history. On 01-14-2021 he passed away with a diagnosis of Cardiomyopathic CHF, A.Fib contributory."
	"1017176-1"	"1017176-1"	"CARDIOMYOPATHY"	"10007636"	"65-79 years"	"65-79"	"Patient had Covid-19 in October of 2020. He recovered. He received the vaccination on 12/30/2020 with no complaints. On 01-05-2021 it was noted to he was incontinent of urine and bilateral lower extremity edema. Lab work was completed showed acute kidney injury. He had decreased blood pressure and oxygen saturations on 01-06-2021 He was admitted to the hospital with rapid progression of symptoms and suggested multi-system failure. He had a long cardiac history. On 01-14-2021 he passed away with a diagnosis of Cardiomyopathic CHF, A.Fib contributory."
	"1017176-1"	"1017176-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient had Covid-19 in October of 2020. He recovered. He received the vaccination on 12/30/2020 with no complaints. On 01-05-2021 it was noted to he was incontinent of urine and bilateral lower extremity edema. Lab work was completed showed acute kidney injury. He had decreased blood pressure and oxygen saturations on 01-06-2021 He was admitted to the hospital with rapid progression of symptoms and suggested multi-system failure. He had a long cardiac history. On 01-14-2021 he passed away with a diagnosis of Cardiomyopathic CHF, A.Fib contributory."
	"1017176-1"	"1017176-1"	"LABORATORY TEST ABNORMAL"	"10023547"	"65-79 years"	"65-79"	"Patient had Covid-19 in October of 2020. He recovered. He received the vaccination on 12/30/2020 with no complaints. On 01-05-2021 it was noted to he was incontinent of urine and bilateral lower extremity edema. Lab work was completed showed acute kidney injury. He had decreased blood pressure and oxygen saturations on 01-06-2021 He was admitted to the hospital with rapid progression of symptoms and suggested multi-system failure. He had a long cardiac history. On 01-14-2021 he passed away with a diagnosis of Cardiomyopathic CHF, A.Fib contributory."
	"1017176-1"	"1017176-1"	"MULTIPLE ORGAN DYSFUNCTION SYNDROME"	"10077361"	"65-79 years"	"65-79"	"Patient had Covid-19 in October of 2020. He recovered. He received the vaccination on 12/30/2020 with no complaints. On 01-05-2021 it was noted to he was incontinent of urine and bilateral lower extremity edema. Lab work was completed showed acute kidney injury. He had decreased blood pressure and oxygen saturations on 01-06-2021 He was admitted to the hospital with rapid progression of symptoms and suggested multi-system failure. He had a long cardiac history. On 01-14-2021 he passed away with a diagnosis of Cardiomyopathic CHF, A.Fib contributory."
	"1017176-1"	"1017176-1"	"OEDEMA PERIPHERAL"	"10030124"	"65-79 years"	"65-79"	"Patient had Covid-19 in October of 2020. He recovered. He received the vaccination on 12/30/2020 with no complaints. On 01-05-2021 it was noted to he was incontinent of urine and bilateral lower extremity edema. Lab work was completed showed acute kidney injury. He had decreased blood pressure and oxygen saturations on 01-06-2021 He was admitted to the hospital with rapid progression of symptoms and suggested multi-system failure. He had a long cardiac history. On 01-14-2021 he passed away with a diagnosis of Cardiomyopathic CHF, A.Fib contributory."
	"1017176-1"	"1017176-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"Patient had Covid-19 in October of 2020. He recovered. He received the vaccination on 12/30/2020 with no complaints. On 01-05-2021 it was noted to he was incontinent of urine and bilateral lower extremity edema. Lab work was completed showed acute kidney injury. He had decreased blood pressure and oxygen saturations on 01-06-2021 He was admitted to the hospital with rapid progression of symptoms and suggested multi-system failure. He had a long cardiac history. On 01-14-2021 he passed away with a diagnosis of Cardiomyopathic CHF, A.Fib contributory."
	"1017176-1"	"1017176-1"	"URINARY INCONTINENCE"	"10046543"	"65-79 years"	"65-79"	"Patient had Covid-19 in October of 2020. He recovered. He received the vaccination on 12/30/2020 with no complaints. On 01-05-2021 it was noted to he was incontinent of urine and bilateral lower extremity edema. Lab work was completed showed acute kidney injury. He had decreased blood pressure and oxygen saturations on 01-06-2021 He was admitted to the hospital with rapid progression of symptoms and suggested multi-system failure. He had a long cardiac history. On 01-14-2021 he passed away with a diagnosis of Cardiomyopathic CHF, A.Fib contributory."
	"1017978-1"	"1017978-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt was deceased when we came for second dose. COD unknown to pharmacy"
	"1019979-1"	"1019979-1"	"ACUTE RESPIRATORY DISTRESS SYNDROME"	"10001052"	"65-79 years"	"65-79"	"Patient received the Moderna COVID vaccine 1/28/21.  He was tested for COVID 19 on 1/29/31.  Results were received 1/30/21, at which time he was evaluated and found to be hypoxic with tachycardia.  He was sent to the local ER and returned this same day.   On 2/2/21, he was evaluated by the provider, who sent him to the emergency room with acute respiratory distress and poor O2 sats"
	"1019979-1"	"1019979-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received the Moderna COVID vaccine 1/28/21.  He was tested for COVID 19 on 1/29/31.  Results were received 1/30/21, at which time he was evaluated and found to be hypoxic with tachycardia.  He was sent to the local ER and returned this same day.   On 2/2/21, he was evaluated by the provider, who sent him to the emergency room with acute respiratory distress and poor O2 sats"
	"1019979-1"	"1019979-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Patient received the Moderna COVID vaccine 1/28/21.  He was tested for COVID 19 on 1/29/31.  Results were received 1/30/21, at which time he was evaluated and found to be hypoxic with tachycardia.  He was sent to the local ER and returned this same day.   On 2/2/21, he was evaluated by the provider, who sent him to the emergency room with acute respiratory distress and poor O2 sats"
	"1019979-1"	"1019979-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Patient received the Moderna COVID vaccine 1/28/21.  He was tested for COVID 19 on 1/29/31.  Results were received 1/30/21, at which time he was evaluated and found to be hypoxic with tachycardia.  He was sent to the local ER and returned this same day.   On 2/2/21, he was evaluated by the provider, who sent him to the emergency room with acute respiratory distress and poor O2 sats"
	"1019979-1"	"1019979-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Patient received the Moderna COVID vaccine 1/28/21.  He was tested for COVID 19 on 1/29/31.  Results were received 1/30/21, at which time he was evaluated and found to be hypoxic with tachycardia.  He was sent to the local ER and returned this same day.   On 2/2/21, he was evaluated by the provider, who sent him to the emergency room with acute respiratory distress and poor O2 sats"
	"1019979-1"	"1019979-1"	"OXYGEN SATURATION ABNORMAL"	"10033317"	"65-79 years"	"65-79"	"Patient received the Moderna COVID vaccine 1/28/21.  He was tested for COVID 19 on 1/29/31.  Results were received 1/30/21, at which time he was evaluated and found to be hypoxic with tachycardia.  He was sent to the local ER and returned this same day.   On 2/2/21, he was evaluated by the provider, who sent him to the emergency room with acute respiratory distress and poor O2 sats"
	"1019979-1"	"1019979-1"	"RESPIRATORY DISTRESS"	"10038687"	"65-79 years"	"65-79"	"Patient received the Moderna COVID vaccine 1/28/21.  He was tested for COVID 19 on 1/29/31.  Results were received 1/30/21, at which time he was evaluated and found to be hypoxic with tachycardia.  He was sent to the local ER and returned this same day.   On 2/2/21, he was evaluated by the provider, who sent him to the emergency room with acute respiratory distress and poor O2 sats"
	"1019979-1"	"1019979-1"	"TACHYCARDIA"	"10043071"	"65-79 years"	"65-79"	"Patient received the Moderna COVID vaccine 1/28/21.  He was tested for COVID 19 on 1/29/31.  Results were received 1/30/21, at which time he was evaluated and found to be hypoxic with tachycardia.  He was sent to the local ER and returned this same day.   On 2/2/21, he was evaluated by the provider, who sent him to the emergency room with acute respiratory distress and poor O2 sats"
	"1020119-1"	"1020119-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"My mother died suddenly on February 3rd. She went into shock/cardiac arrest and appeared to have internal bleeding. No autopsy has been performed. Unsure if it was related to the COVID vaccine."
	"1020119-1"	"1020119-1"	"INTERNAL HAEMORRHAGE"	"10075192"	"65-79 years"	"65-79"	"My mother died suddenly on February 3rd. She went into shock/cardiac arrest and appeared to have internal bleeding. No autopsy has been performed. Unsure if it was related to the COVID vaccine."
	"1020119-1"	"1020119-1"	"SHOCK"	"10040560"	"65-79 years"	"65-79"	"My mother died suddenly on February 3rd. She went into shock/cardiac arrest and appeared to have internal bleeding. No autopsy has been performed. Unsure if it was related to the COVID vaccine."
	"1020119-1"	"1020119-1"	"SUDDEN DEATH"	"10042434"	"65-79 years"	"65-79"	"My mother died suddenly on February 3rd. She went into shock/cardiac arrest and appeared to have internal bleeding. No autopsy has been performed. Unsure if it was related to the COVID vaccine."
	"1020684-1"	"1020684-1"	"ANTICONVULSANT DRUG LEVEL DECREASED"	"10057857"	"65-79 years"	"65-79"	"Patient received vaccine at Public Health Clinic. Patient ended up having a seizure 3 days later and ended up in the hospital. Found to have right lobe pneumonia and low depakote level. Patient noted to have multiple seizures at hospital, issues with stabilizing HR and BP, and passed away on 1/20/21."
	"1020684-1"	"1020684-1"	"BLOOD PRESSURE ABNORMAL"	"10005728"	"65-79 years"	"65-79"	"Patient received vaccine at Public Health Clinic. Patient ended up having a seizure 3 days later and ended up in the hospital. Found to have right lobe pneumonia and low depakote level. Patient noted to have multiple seizures at hospital, issues with stabilizing HR and BP, and passed away on 1/20/21."
	"1020684-1"	"1020684-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received vaccine at Public Health Clinic. Patient ended up having a seizure 3 days later and ended up in the hospital. Found to have right lobe pneumonia and low depakote level. Patient noted to have multiple seizures at hospital, issues with stabilizing HR and BP, and passed away on 1/20/21."
	"1020684-1"	"1020684-1"	"HEART RATE ABNORMAL"	"10019300"	"65-79 years"	"65-79"	"Patient received vaccine at Public Health Clinic. Patient ended up having a seizure 3 days later and ended up in the hospital. Found to have right lobe pneumonia and low depakote level. Patient noted to have multiple seizures at hospital, issues with stabilizing HR and BP, and passed away on 1/20/21."
	"1020684-1"	"1020684-1"	"PNEUMONIA"	"10035664"	"65-79 years"	"65-79"	"Patient received vaccine at Public Health Clinic. Patient ended up having a seizure 3 days later and ended up in the hospital. Found to have right lobe pneumonia and low depakote level. Patient noted to have multiple seizures at hospital, issues with stabilizing HR and BP, and passed away on 1/20/21."
	"1020684-1"	"1020684-1"	"SEIZURE"	"10039906"	"65-79 years"	"65-79"	"Patient received vaccine at Public Health Clinic. Patient ended up having a seizure 3 days later and ended up in the hospital. Found to have right lobe pneumonia and low depakote level. Patient noted to have multiple seizures at hospital, issues with stabilizing HR and BP, and passed away on 1/20/21."
	"1020749-1"	"1020749-1"	"CYANOSIS"	"10011703"	"65-79 years"	"65-79"	"Patient had no reaction at the clinic.  Patient is a medical doctor whose partner called in this death.  States patient had no  complaint on 1/13 nor 1/14 while at work.  States patient died at home on 1/15 a.m.  Physician who stated she was called to the patient's home @ 0157 1/15/2021 and found cyanotic from head to toe.  State girlfriend found him sitting in the chair a few minutes before they called her.  The Coroner did not order autopsy.  Did not sent patient to the hospital.  Sent him directly Funeral Home.  Death Certificate Number 123-2021-002593 list cause of death as pending.  I spoke with the patient's primary doctor who gave me the history of HTN, Diabetes, & High Cholesterol.  States he had not seen this patient since April 2020.  They were also friends and he was not aware of any medical problems.   The Coroner state she thinks patient has a heart attack.   Neither the Coroner nor PMD think death was related to COVID Vaccine.    Informed both that MSDH would have to complete VAERS.  Both voiced understanding."
	"1020749-1"	"1020749-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient had no reaction at the clinic.  Patient is a medical doctor whose partner called in this death.  States patient had no  complaint on 1/13 nor 1/14 while at work.  States patient died at home on 1/15 a.m.  Physician who stated she was called to the patient's home @ 0157 1/15/2021 and found cyanotic from head to toe.  State girlfriend found him sitting in the chair a few minutes before they called her.  The Coroner did not order autopsy.  Did not sent patient to the hospital.  Sent him directly Funeral Home.  Death Certificate Number 123-2021-002593 list cause of death as pending.  I spoke with the patient's primary doctor who gave me the history of HTN, Diabetes, & High Cholesterol.  States he had not seen this patient since April 2020.  They were also friends and he was not aware of any medical problems.   The Coroner state she thinks patient has a heart attack.   Neither the Coroner nor PMD think death was related to COVID Vaccine.    Informed both that MSDH would have to complete VAERS.  Both voiced understanding."
	"1020749-1"	"1020749-1"	"MYOCARDIAL INFARCTION"	"10028596"	"65-79 years"	"65-79"	"Patient had no reaction at the clinic.  Patient is a medical doctor whose partner called in this death.  States patient had no  complaint on 1/13 nor 1/14 while at work.  States patient died at home on 1/15 a.m.  Physician who stated she was called to the patient's home @ 0157 1/15/2021 and found cyanotic from head to toe.  State girlfriend found him sitting in the chair a few minutes before they called her.  The Coroner did not order autopsy.  Did not sent patient to the hospital.  Sent him directly Funeral Home.  Death Certificate Number 123-2021-002593 list cause of death as pending.  I spoke with the patient's primary doctor who gave me the history of HTN, Diabetes, & High Cholesterol.  States he had not seen this patient since April 2020.  They were also friends and he was not aware of any medical problems.   The Coroner state she thinks patient has a heart attack.   Neither the Coroner nor PMD think death was related to COVID Vaccine.    Informed both that MSDH would have to complete VAERS.  Both voiced understanding."
	"1021058-1"	"1021058-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient had passed since the first dose was given."
	"1022160-1"	"1022160-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"24 hours after shot had high fever 101, chills, weakness, became listless, family called 911,  client became unresponsive and died  in the Emergency room."
	"1022160-1"	"1022160-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"24 hours after shot had high fever 101, chills, weakness, became listless, family called 911,  client became unresponsive and died  in the Emergency room."
	"1022160-1"	"1022160-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"24 hours after shot had high fever 101, chills, weakness, became listless, family called 911,  client became unresponsive and died  in the Emergency room."
	"1022160-1"	"1022160-1"	"LISTLESS"	"10024642"	"65-79 years"	"65-79"	"24 hours after shot had high fever 101, chills, weakness, became listless, family called 911,  client became unresponsive and died  in the Emergency room."
	"1022160-1"	"1022160-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"24 hours after shot had high fever 101, chills, weakness, became listless, family called 911,  client became unresponsive and died  in the Emergency room."
	"1022160-1"	"1022160-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"24 hours after shot had high fever 101, chills, weakness, became listless, family called 911,  client became unresponsive and died  in the Emergency room."
	"1026045-1"	"1026045-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"On 2/7/21 resident complainted of not feeling well, nausea, vomiting and weakness sent to ER passed away."
	"1026045-1"	"1026045-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"On 2/7/21 resident complainted of not feeling well, nausea, vomiting and weakness sent to ER passed away."
	"1026045-1"	"1026045-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"On 2/7/21 resident complainted of not feeling well, nausea, vomiting and weakness sent to ER passed away."
	"1026045-1"	"1026045-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"On 2/7/21 resident complainted of not feeling well, nausea, vomiting and weakness sent to ER passed away."
	"1026045-1"	"1026045-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"On 2/7/21 resident complainted of not feeling well, nausea, vomiting and weakness sent to ER passed away."
	"1026443-1"	"1026443-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Received first 1/15/2021 with no adverse reaction.  Received 2nd dose 2/9 @ 0846 with no adverse reaction or report of feeling ill.  Traveled to store and arrived approx. 2 hours after receiving vaccine.  Daughter stated patient felt well and had to go to the restroom to have BM.  Collapsed in bathroom.  Transported by ambulance to Hospital @ 1439 in cardiac arrest.  Was in PEA and went in v fib back to PEA. Resuscitation efforts initiated and patient expired with time noted at hospital records at 15:11."
	"1026443-1"	"1026443-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Received first 1/15/2021 with no adverse reaction.  Received 2nd dose 2/9 @ 0846 with no adverse reaction or report of feeling ill.  Traveled to store and arrived approx. 2 hours after receiving vaccine.  Daughter stated patient felt well and had to go to the restroom to have BM.  Collapsed in bathroom.  Transported by ambulance to Hospital @ 1439 in cardiac arrest.  Was in PEA and went in v fib back to PEA. Resuscitation efforts initiated and patient expired with time noted at hospital records at 15:11."
	"1026443-1"	"1026443-1"	"PULSELESS ELECTRICAL ACTIVITY"	"10058151"	"65-79 years"	"65-79"	"Received first 1/15/2021 with no adverse reaction.  Received 2nd dose 2/9 @ 0846 with no adverse reaction or report of feeling ill.  Traveled to store and arrived approx. 2 hours after receiving vaccine.  Daughter stated patient felt well and had to go to the restroom to have BM.  Collapsed in bathroom.  Transported by ambulance to Hospital @ 1439 in cardiac arrest.  Was in PEA and went in v fib back to PEA. Resuscitation efforts initiated and patient expired with time noted at hospital records at 15:11."
	"1026443-1"	"1026443-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Received first 1/15/2021 with no adverse reaction.  Received 2nd dose 2/9 @ 0846 with no adverse reaction or report of feeling ill.  Traveled to store and arrived approx. 2 hours after receiving vaccine.  Daughter stated patient felt well and had to go to the restroom to have BM.  Collapsed in bathroom.  Transported by ambulance to Hospital @ 1439 in cardiac arrest.  Was in PEA and went in v fib back to PEA. Resuscitation efforts initiated and patient expired with time noted at hospital records at 15:11."
	"1026443-1"	"1026443-1"	"SYNCOPE"	"10042772"	"65-79 years"	"65-79"	"Received first 1/15/2021 with no adverse reaction.  Received 2nd dose 2/9 @ 0846 with no adverse reaction or report of feeling ill.  Traveled to store and arrived approx. 2 hours after receiving vaccine.  Daughter stated patient felt well and had to go to the restroom to have BM.  Collapsed in bathroom.  Transported by ambulance to Hospital @ 1439 in cardiac arrest.  Was in PEA and went in v fib back to PEA. Resuscitation efforts initiated and patient expired with time noted at hospital records at 15:11."
	"1026443-1"	"1026443-1"	"VENTRICULAR FIBRILLATION"	"10047290"	"65-79 years"	"65-79"	"Received first 1/15/2021 with no adverse reaction.  Received 2nd dose 2/9 @ 0846 with no adverse reaction or report of feeling ill.  Traveled to store and arrived approx. 2 hours after receiving vaccine.  Daughter stated patient felt well and had to go to the restroom to have BM.  Collapsed in bathroom.  Transported by ambulance to Hospital @ 1439 in cardiac arrest.  Was in PEA and went in v fib back to PEA. Resuscitation efforts initiated and patient expired with time noted at hospital records at 15:11."
	"1027967-1"	"1027967-1"	"COAGULOPATHY"	"10009802"	"65-79 years"	"65-79"	"Patient received vaccination on 1/15/2021. Hemorrhagic Stroke on 1/20 , then diagnosed with complicated idiopathic coagulopathy"
	"1027967-1"	"1027967-1"	"HAEMORRHAGIC STROKE"	"10019016"	"65-79 years"	"65-79"	"Patient received vaccination on 1/15/2021. Hemorrhagic Stroke on 1/20 , then diagnosed with complicated idiopathic coagulopathy"
	"1028217-1"	"1028217-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"DEATH"
	"1030468-1"	"1030468-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"Pt presents to ER with increased weakness, hypoxia,  history of COPD, but not oxygen dependent., hypotension.  Acute Kidney failure  noted in labs,  not previously  diagnosed , new hyperkalemia.  BP 73/39, HR 67. dopamine  initiated, and switched to Levophed.  Oxygen Sat  86%, requiring 10 L  O2.  Transferred from this critical access hospital to another Hospital.  Expires later 2-13-2021"
	"1030468-1"	"1030468-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Pt presents to ER with increased weakness, hypoxia,  history of COPD, but not oxygen dependent., hypotension.  Acute Kidney failure  noted in labs,  not previously  diagnosed , new hyperkalemia.  BP 73/39, HR 67. dopamine  initiated, and switched to Levophed.  Oxygen Sat  86%, requiring 10 L  O2.  Transferred from this critical access hospital to another Hospital.  Expires later 2-13-2021"
	"1030468-1"	"1030468-1"	"BLOOD CREATININE INCREASED"	"10005483"	"65-79 years"	"65-79"	"Pt presents to ER with increased weakness, hypoxia,  history of COPD, but not oxygen dependent., hypotension.  Acute Kidney failure  noted in labs,  not previously  diagnosed , new hyperkalemia.  BP 73/39, HR 67. dopamine  initiated, and switched to Levophed.  Oxygen Sat  86%, requiring 10 L  O2.  Transferred from this critical access hospital to another Hospital.  Expires later 2-13-2021"
	"1030468-1"	"1030468-1"	"BLOOD POTASSIUM INCREASED"	"10005725"	"65-79 years"	"65-79"	"Pt presents to ER with increased weakness, hypoxia,  history of COPD, but not oxygen dependent., hypotension.  Acute Kidney failure  noted in labs,  not previously  diagnosed , new hyperkalemia.  BP 73/39, HR 67. dopamine  initiated, and switched to Levophed.  Oxygen Sat  86%, requiring 10 L  O2.  Transferred from this critical access hospital to another Hospital.  Expires later 2-13-2021"
	"1030468-1"	"1030468-1"	"BRAIN NATRIURETIC PEPTIDE INCREASED"	"10053405"	"65-79 years"	"65-79"	"Pt presents to ER with increased weakness, hypoxia,  history of COPD, but not oxygen dependent., hypotension.  Acute Kidney failure  noted in labs,  not previously  diagnosed , new hyperkalemia.  BP 73/39, HR 67. dopamine  initiated, and switched to Levophed.  Oxygen Sat  86%, requiring 10 L  O2.  Transferred from this critical access hospital to another Hospital.  Expires later 2-13-2021"
	"1030468-1"	"1030468-1"	"C-REACTIVE PROTEIN INCREASED"	"10006825"	"65-79 years"	"65-79"	"Pt presents to ER with increased weakness, hypoxia,  history of COPD, but not oxygen dependent., hypotension.  Acute Kidney failure  noted in labs,  not previously  diagnosed , new hyperkalemia.  BP 73/39, HR 67. dopamine  initiated, and switched to Levophed.  Oxygen Sat  86%, requiring 10 L  O2.  Transferred from this critical access hospital to another Hospital.  Expires later 2-13-2021"
	"1030468-1"	"1030468-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt presents to ER with increased weakness, hypoxia,  history of COPD, but not oxygen dependent., hypotension.  Acute Kidney failure  noted in labs,  not previously  diagnosed , new hyperkalemia.  BP 73/39, HR 67. dopamine  initiated, and switched to Levophed.  Oxygen Sat  86%, requiring 10 L  O2.  Transferred from this critical access hospital to another Hospital.  Expires later 2-13-2021"
	"1030468-1"	"1030468-1"	"HYPERKALAEMIA"	"10020646"	"65-79 years"	"65-79"	"Pt presents to ER with increased weakness, hypoxia,  history of COPD, but not oxygen dependent., hypotension.  Acute Kidney failure  noted in labs,  not previously  diagnosed , new hyperkalemia.  BP 73/39, HR 67. dopamine  initiated, and switched to Levophed.  Oxygen Sat  86%, requiring 10 L  O2.  Transferred from this critical access hospital to another Hospital.  Expires later 2-13-2021"
	"1030468-1"	"1030468-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	"Pt presents to ER with increased weakness, hypoxia,  history of COPD, but not oxygen dependent., hypotension.  Acute Kidney failure  noted in labs,  not previously  diagnosed , new hyperkalemia.  BP 73/39, HR 67. dopamine  initiated, and switched to Levophed.  Oxygen Sat  86%, requiring 10 L  O2.  Transferred from this critical access hospital to another Hospital.  Expires later 2-13-2021"
	"1030468-1"	"1030468-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Pt presents to ER with increased weakness, hypoxia,  history of COPD, but not oxygen dependent., hypotension.  Acute Kidney failure  noted in labs,  not previously  diagnosed , new hyperkalemia.  BP 73/39, HR 67. dopamine  initiated, and switched to Levophed.  Oxygen Sat  86%, requiring 10 L  O2.  Transferred from this critical access hospital to another Hospital.  Expires later 2-13-2021"
	"1030468-1"	"1030468-1"	"WHITE BLOOD CELL COUNT INCREASED"	"10047943"	"65-79 years"	"65-79"	"Pt presents to ER with increased weakness, hypoxia,  history of COPD, but not oxygen dependent., hypotension.  Acute Kidney failure  noted in labs,  not previously  diagnosed , new hyperkalemia.  BP 73/39, HR 67. dopamine  initiated, and switched to Levophed.  Oxygen Sat  86%, requiring 10 L  O2.  Transferred from this critical access hospital to another Hospital.  Expires later 2-13-2021"
	"1030712-1"	"1030712-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"2/10: Fever, fatigue, tylenol 2/11 @ 1300: pt made DNR, hospice consulted 2/11 @ 1800 decreased LOC, increased RR, fever, chills - 1/5L NS bolus IV, rectal tylenol. Refusing to eat/drink, PO morphine 2/12 @ 16:30, deceased at facility **resident was not doing well prior to vaccination"
	"1030712-1"	"1030712-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"2/10: Fever, fatigue, tylenol 2/11 @ 1300: pt made DNR, hospice consulted 2/11 @ 1800 decreased LOC, increased RR, fever, chills - 1/5L NS bolus IV, rectal tylenol. Refusing to eat/drink, PO morphine 2/12 @ 16:30, deceased at facility **resident was not doing well prior to vaccination"
	"1030712-1"	"1030712-1"	"DECREASED APPETITE"	"10061428"	"65-79 years"	"65-79"	"2/10: Fever, fatigue, tylenol 2/11 @ 1300: pt made DNR, hospice consulted 2/11 @ 1800 decreased LOC, increased RR, fever, chills - 1/5L NS bolus IV, rectal tylenol. Refusing to eat/drink, PO morphine 2/12 @ 16:30, deceased at facility **resident was not doing well prior to vaccination"
	"1030712-1"	"1030712-1"	"DEPRESSED LEVEL OF CONSCIOUSNESS"	"10012373"	"65-79 years"	"65-79"	"2/10: Fever, fatigue, tylenol 2/11 @ 1300: pt made DNR, hospice consulted 2/11 @ 1800 decreased LOC, increased RR, fever, chills - 1/5L NS bolus IV, rectal tylenol. Refusing to eat/drink, PO morphine 2/12 @ 16:30, deceased at facility **resident was not doing well prior to vaccination"
	"1030712-1"	"1030712-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"2/10: Fever, fatigue, tylenol 2/11 @ 1300: pt made DNR, hospice consulted 2/11 @ 1800 decreased LOC, increased RR, fever, chills - 1/5L NS bolus IV, rectal tylenol. Refusing to eat/drink, PO morphine 2/12 @ 16:30, deceased at facility **resident was not doing well prior to vaccination"
	"1030712-1"	"1030712-1"	"FOOD REFUSAL"	"10080283"	"65-79 years"	"65-79"	"2/10: Fever, fatigue, tylenol 2/11 @ 1300: pt made DNR, hospice consulted 2/11 @ 1800 decreased LOC, increased RR, fever, chills - 1/5L NS bolus IV, rectal tylenol. Refusing to eat/drink, PO morphine 2/12 @ 16:30, deceased at facility **resident was not doing well prior to vaccination"
	"1030712-1"	"1030712-1"	"LOSS OF CONSCIOUSNESS"	"10024855"	"65-79 years"	"65-79"	"2/10: Fever, fatigue, tylenol 2/11 @ 1300: pt made DNR, hospice consulted 2/11 @ 1800 decreased LOC, increased RR, fever, chills - 1/5L NS bolus IV, rectal tylenol. Refusing to eat/drink, PO morphine 2/12 @ 16:30, deceased at facility **resident was not doing well prior to vaccination"
	"1030712-1"	"1030712-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"2/10: Fever, fatigue, tylenol 2/11 @ 1300: pt made DNR, hospice consulted 2/11 @ 1800 decreased LOC, increased RR, fever, chills - 1/5L NS bolus IV, rectal tylenol. Refusing to eat/drink, PO morphine 2/12 @ 16:30, deceased at facility **resident was not doing well prior to vaccination"
	"1030712-1"	"1030712-1"	"RESPIRATORY RATE INCREASED"	"10038712"	"65-79 years"	"65-79"	"2/10: Fever, fatigue, tylenol 2/11 @ 1300: pt made DNR, hospice consulted 2/11 @ 1800 decreased LOC, increased RR, fever, chills - 1/5L NS bolus IV, rectal tylenol. Refusing to eat/drink, PO morphine 2/12 @ 16:30, deceased at facility **resident was not doing well prior to vaccination"
	"1035897-1"	"1035897-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Patient received her vaccine on 2/2/2021 in the morning. She was observed for over 15 minutes and had no history of any anaphylactic reaction of any sort. She felt fine and went home. 2/15/2021 we were notified by her family that she had passed away on 2/7/2021 at home. The cause of death was stated as myocardial infarct secondary to coronary artery disease. We do not think it had to do with the vaccine administration. The patient had many comorbidities."
	"1035897-1"	"1035897-1"	"CORONARY ARTERY DISEASE"	"10011078"	"65-79 years"	"65-79"	"Patient received her vaccine on 2/2/2021 in the morning. She was observed for over 15 minutes and had no history of any anaphylactic reaction of any sort. She felt fine and went home. 2/15/2021 we were notified by her family that she had passed away on 2/7/2021 at home. The cause of death was stated as myocardial infarct secondary to coronary artery disease. We do not think it had to do with the vaccine administration. The patient had many comorbidities."
	"1035897-1"	"1035897-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received her vaccine on 2/2/2021 in the morning. She was observed for over 15 minutes and had no history of any anaphylactic reaction of any sort. She felt fine and went home. 2/15/2021 we were notified by her family that she had passed away on 2/7/2021 at home. The cause of death was stated as myocardial infarct secondary to coronary artery disease. We do not think it had to do with the vaccine administration. The patient had many comorbidities."
	"1035897-1"	"1035897-1"	"MYOCARDIAL INFARCTION"	"10028596"	"65-79 years"	"65-79"	"Patient received her vaccine on 2/2/2021 in the morning. She was observed for over 15 minutes and had no history of any anaphylactic reaction of any sort. She felt fine and went home. 2/15/2021 we were notified by her family that she had passed away on 2/7/2021 at home. The cause of death was stated as myocardial infarct secondary to coronary artery disease. We do not think it had to do with the vaccine administration. The patient had many comorbidities."
	"1036787-1"	"1036787-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"passed away 2 days after vaccine was given"
	"1038517-1"	"1038517-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"65-79 years"	"65-79"	"Pt. received vaccine on 2/3/2021. Coded at home on 2/17/2021."
	"1038517-1"	"1038517-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt. received vaccine on 2/3/2021. Coded at home on 2/17/2021."
	"1038517-1"	"1038517-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	"Pt. received vaccine on 2/3/2021. Coded at home on 2/17/2021."
	"1041333-1"	"1041333-1"	"BEDRIDDEN"	"10048948"	"65-79 years"	"65-79"	"He developed a fever on 1/8, become unable to swallow and bedbound. He was already end of life and Hospice care at the time of the vaccine."
	"1041333-1"	"1041333-1"	"DYSPHAGIA"	"10013950"	"65-79 years"	"65-79"	"He developed a fever on 1/8, become unable to swallow and bedbound. He was already end of life and Hospice care at the time of the vaccine."
	"1041333-1"	"1041333-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"He developed a fever on 1/8, become unable to swallow and bedbound. He was already end of life and Hospice care at the time of the vaccine."
	"1041740-1"	"1041740-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient died on 2-13-21"
	"1045635-1"	"1045635-1"	"ABDOMINAL DISCOMFORT"	"10000059"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"BODY TEMPERATURE"	"10005906"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"CONSTIPATION"	"10010774"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"DIARRHOEA"	"10012735"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"DYSPHONIA"	"10013952"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"HYPERHIDROSIS"	"10020642"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"LOSS OF CONSCIOUSNESS"	"10024855"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"MYALGIA"	"10028411"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"NASOPHARYNGITIS"	"10028810"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"SENSATION OF FOREIGN BODY"	"10061549"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1045635-1"	"1045635-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"Death; Passed out; Stomach was bothering; Constipated; Difficulty breathing; Weakness/Event: Weakness was reported as worsened; a temperature of 99.4 degrees; Sweaty; Cold; Muscle ache; Body Aches; Diarrhea; Nausea; Vomiting; Fatigue/Tiredness; His raspy throat felt like he had mucus stuck in his throat; Cough; Raspy throat/worsened; This is a spontaneous report from a contactable consumer reporting her husband. A 75-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EM9810, Expiry Date: Jun2021) at the age of 74- year-old via an unspecified route of administration on 04Feb2021 09:15 at single dose in Arm, Right for COVID-19 immunisation. Medical history included type 2 diabetes mellitus for about 20-25 years, ongoing kidney disease from 2005, ongoing chronic kidney disease, cardiac pacemaker insertion. The patient was diagnosed with kidney disease in 2005, but it was about 1 to 1-1/2 years ago that his kidney disease progressed to Stage 4 Kidney Disease. She said the Veterans Administration diagnosed her husband with his kidney disease, but her husband saw a private doctor, as well as, a VA doctor for his care. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (Lot Number: EL3248; Expiration Date: Apr2021) at the age of 74- year-old Intramuscularly at approximately 08:45AM on 15Jan2021 in right arm for COVID-19 immunisation and had no reaction. There were no additional vaccines administered on same date of the Pfizer suspect. There were no Prior Vaccinations within 4 weeks. The patient had symptoms start earlier in the day of Tuesday, 09Feb2021, after his second COVID-19 Vaccine shot (04Feb2021). The reporter said she and her husband didn't think anything of his symptoms at first. The patient had a temperature of 99.4 degrees on 09Feb2021. She didn't check her husband's temperature again after that time because the nurse at her husband's doctor's office said her husband's temperature was not at an area of concern. The patient was sweaty, off and on, starting 09Feb2021. She clarified he would be sweaty and the cold, but nothing extreme. The patient developed muscle aches, body aches, diarrhea, nausea, and vomiting on 09Feb2021. She clarified her husband had fatigue, tiredness, and had trouble with a raspy throat. His raspy throat started Tuesday evening (09Feb2021). His raspy throat felt like he had mucus stuck in his throat, and he was unable to clear the mucus from his throat. The reporter called her husband's primary care doctor on the morning of 10Feb2021 because her husband was having trouble with a raspy throat, and difficulty breathing. She said on Tuesday night (09Feb2021) her husband had to sleep sitting up because he couldn't lay down with his breathing.  He was able to eat breakfast (clarified as oatmeal and an orange), lunch (clarified as soup and a salad), and dinner (clarified as soup and half a sandwich. She said her husband ate all the meat and half of the bread on the sandwich) on 10Feb2021. Her husband's primary care doctor wasn't available to speak to on Wednesday morning (10Feb2021), but the doctor's nurse said it sounded like her husband was having a reaction to his second COVID-19 Vaccine shot. The reporter said her husband's doctor instructed her later in the day to take her husband to the Emergency Room or Urgent Care if he didn't feel any better. Her husband's throat raspiness got worse in the evening of 10Feb2021. His breathing also became worse after dinner in the evening of 10Feb2021. The patient leaned forward over a couple pillows while sitting on their couch as it was easier for him to breath by doing that. They decided at 11:00PM that her husband should go to the Emergency Room. She said her husband was getting very weak, so she and her husband debated if she should call # for an ambulance, or if she should drive him to the Emergency Room. She said her husband was able to dress himself, but with some difficulty, and she assisted walking him from their house to their car. She said she had turned to walk away from her husband while he was at the side of their car, and then she heard her husband make a noise. He had appeared to have passed out. She clarified in the past, her husband had passed out prior to his pacemaker. She said she dialed #, and the # operator told her how to tell if her husband was still breathing. She said she couldn't tell if her husband was still breathing. She said when the ambulance arrived at her house, the ambulance staff worked on her husband for a long time. The reporter thought her husband had died at the time he had collapsed at the side of their car. The patient took a sugar free cough syrup Tuesday night (09Feb2021), and then again a couple times on Wednesday (10Feb2021) as treatment. The patient had thrown up a couple times, but found that the sugar free cough syrup soothed his cough the night before (09Feb2021). She said her husband had taken 2 TUMS early on Wednesday morning at approximately 2:00AM (10Feb2021). He had said his stomach was bothering him on 10Feb2021. He said he thought he may be constipated, so he took 1 Senokot (Clarified as GeriCare Senna-Plus Natural Vegetable Laxative with Stool Softener) on 10Feb2021. She clarified her husband had diarrhea on 09Feb2021, but felt on 10Feb2021 he may have been constipated. There were no adverse events required a visit to Emergency Room since Patient's wife stated she was getting her husband to their car, so she could drive him to the Emergency Room, when her husband collapsed and died or to Physician Office as they spoke with the nurse at her husband's primary care doctor's office. Weakness was reported as worsened. The outcome of events Sweaty, Cold, Muscle ache, Body Aches, Fatigue/Tiredness, Raspy throat/worsened, Difficulty breathing, Weakness was not recovered; and of the remaining events was unknown. The patient died on 11Feb2021. The patient's official time of death was Thursday, 11Feb2021, at 12:08AM. Cause of death was unknown. An autopsy was not performed and it would take 3 weeks for a death certificate to be issued. The reporter stated she thought it was important to notify Pfizer of her husband's passing because his side effects fell within the expected time period after receiving his second COVID-19 Vaccine.; Reported Cause(s) of Death: Death"
	"1049428-1"	"1049428-1"	"BLOOD ALBUMIN DECREASED"	"10005287"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"BLOOD CREATININE NORMAL"	"10005484"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"BLOOD GLUCOSE INCREASED"	"10005557"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"BLOOD SODIUM INCREASED"	"10005803"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"BLOOD UREA INCREASED"	"10005851"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"BODY TEMPERATURE INCREASED"	"10005911"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"CARBON DIOXIDE INCREASED"	"10007225"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"DECREASED APPETITE"	"10061428"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"DISCOMFORT"	"10013082"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"DYSPHAGIA"	"10013950"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"FEELING COLD"	"10016326"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"HEART RATE INCREASED"	"10019303"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"HYPERHIDROSIS"	"10020642"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"LETHARGY"	"10024264"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"MASTICATION DISORDER"	"10026882"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"PERIPHERAL COLDNESS"	"10034568"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"PREALBUMIN"	"10036508"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"RESPIRATORY ARREST"	"10038669"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"RESTLESSNESS"	"10038743"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1049428-1"	"1049428-1"	"WEIGHT DECREASED"	"10047895"	"65-79 years"	"65-79"	"2/7/21 Increased difficulty chewing, swallowing, evaluated by SLP and dietician. Diet texture down-graded x 2 with poor appetite and recent 6lb weight loss.  2/8/21-APRN updated regarding poor appetite and difficulty chewing as well as downgraded texture of diet. Also informed of increased s/s of discomfort and increased use of PRN Oxycodone for pain. 2/9/21- elevated temp 100.7. 2/9/21 Covid pcr test negative. 2/9/21-N.O.?s APRN BMP, Albumin and Pre-albumin Level in am. 2/11/21-elevated temp 100.4. Covid rapid test negative. 2/12/21- CBG recorded at 517 at 5:20 am. Resident also has an elevated temp of 100.9. Tylenol administered per order. Vital signs include resp 24, radial pulse 134, O2 sat 83%. Supplemental oxygen administered via nasal cannula. Head of bed elevated. DR. notified at time via telephone. Order given for sliding scale for CBG. Guardian updated regarding changes in residents condition, poor prognosis. Guardian requests Hospice eval and admit. Guardian requests comfort care no hospitalization, no IV's, no G-tubes, no labs etc, D/C of Palliative services. ARNP informed. 2/12/21 Acute Telehealth visit with APRN due to increased lethargy, elevated CBG?s despite poor appetite and insulin administration. Resident unresponsive to verbal and noxious stimuli at time of visit. N.O. Morphine sulfate 20mg/ml, give 2.5mg PO/SL Q4hr PRN pain/shortness of breath. 2/12/2021-Admitted to Hospice, Lethargic, diaphoretic, T 98.1 P 130's R 18 O2 high 80's to low 90's via O2 mask at 3L. 2/12/2021- Resident legs and arms noted to feel cool this afternoon, 02 sat was 97% with 02 on @ 3L with mask Noted resident with sob and increased pulse. Prn morphine 0.25ml sl. given with good effect. Resident was less restless and quiet in her bed. Checked on resident several times this shift for needs. Resident noted to not move in her bed @ 8:15pm and noted she was not breathing. Supervisor called and pronounced resident deceased."
	"1050201-1"	"1050201-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Died 7 days after receiving 2nd dose of Moderna vaccine. Had underlying hx Lung CA w/mets."
	"1052049-1"	"1052049-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient was into the clinic on the afternoon of 2/23/21 for a COVID-19 vaccine.  He had a podiatry clinic visit after his vaccine same day.  It was reported by the patients family physician that patient stated he didn't feel well and suddenly collapsed at home at approximately 4:45 pm.  Emergency medical personnel were not able to revive him.   Patient died at approximately 4:45 pm on 2/23/21."
	"1052049-1"	"1052049-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Patient was into the clinic on the afternoon of 2/23/21 for a COVID-19 vaccine.  He had a podiatry clinic visit after his vaccine same day.  It was reported by the patients family physician that patient stated he didn't feel well and suddenly collapsed at home at approximately 4:45 pm.  Emergency medical personnel were not able to revive him.   Patient died at approximately 4:45 pm on 2/23/21."
	"1052049-1"	"1052049-1"	"PAIN IN EXTREMITY"	"10033425"	"65-79 years"	"65-79"	"Patient was into the clinic on the afternoon of 2/23/21 for a COVID-19 vaccine.  He had a podiatry clinic visit after his vaccine same day.  It was reported by the patients family physician that patient stated he didn't feel well and suddenly collapsed at home at approximately 4:45 pm.  Emergency medical personnel were not able to revive him.   Patient died at approximately 4:45 pm on 2/23/21."
	"1052049-1"	"1052049-1"	"PERIPHERAL SWELLING"	"10048959"	"65-79 years"	"65-79"	"Patient was into the clinic on the afternoon of 2/23/21 for a COVID-19 vaccine.  He had a podiatry clinic visit after his vaccine same day.  It was reported by the patients family physician that patient stated he didn't feel well and suddenly collapsed at home at approximately 4:45 pm.  Emergency medical personnel were not able to revive him.   Patient died at approximately 4:45 pm on 2/23/21."
	"1052049-1"	"1052049-1"	"SYNCOPE"	"10042772"	"65-79 years"	"65-79"	"Patient was into the clinic on the afternoon of 2/23/21 for a COVID-19 vaccine.  He had a podiatry clinic visit after his vaccine same day.  It was reported by the patients family physician that patient stated he didn't feel well and suddenly collapsed at home at approximately 4:45 pm.  Emergency medical personnel were not able to revive him.   Patient died at approximately 4:45 pm on 2/23/21."
	"1053322-1"	"1053322-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt had passed away before second dose"
	"1054080-1"	"1054080-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"cardiac arrest, death:  2/21/21"
	"1054080-1"	"1054080-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"cardiac arrest, death:  2/21/21"
	"1061226-1"	"1061226-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"death"
	"1063522-1"	"1063522-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"1. Fatigue ? day 1 - Tuesday 2. Loss of appetite ? day 1 Tuesday 3. Fever 102.0 ? day 2 - Wednesday 4. Chills ? day 2 - - Wednesday 5. Weak ? day 2 - - Wednesday 6. Non-ambulatory (unusual) ? day 2 - - Wednesday 7. Two emergency service ambulance assessment ? day 2 - - Wednesday 8. Symptoms improved ? day 3  - Thursday 9. Ambulatory  - day 3 - Thursday 10. Symptoms worsened ? day 4 - Friday 11. Chills ? day 4 - Friday 12. Non-ambulatory again ? day 4 - Friday 13. Fever 102.0 ? day 4 - Friday 14. Left side flank pain ? day 4 - Friday 15. CPR and declared decease at home by paramedics - day 5 - Saturday morning @ 1:32am"
	"1063522-1"	"1063522-1"	"BLOOD GLUCOSE"	"10005553"	"65-79 years"	"65-79"	"1. Fatigue ? day 1 - Tuesday 2. Loss of appetite ? day 1 Tuesday 3. Fever 102.0 ? day 2 - Wednesday 4. Chills ? day 2 - - Wednesday 5. Weak ? day 2 - - Wednesday 6. Non-ambulatory (unusual) ? day 2 - - Wednesday 7. Two emergency service ambulance assessment ? day 2 - - Wednesday 8. Symptoms improved ? day 3  - Thursday 9. Ambulatory  - day 3 - Thursday 10. Symptoms worsened ? day 4 - Friday 11. Chills ? day 4 - Friday 12. Non-ambulatory again ? day 4 - Friday 13. Fever 102.0 ? day 4 - Friday 14. Left side flank pain ? day 4 - Friday 15. CPR and declared decease at home by paramedics - day 5 - Saturday morning @ 1:32am"
	"1063522-1"	"1063522-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"1. Fatigue ? day 1 - Tuesday 2. Loss of appetite ? day 1 Tuesday 3. Fever 102.0 ? day 2 - Wednesday 4. Chills ? day 2 - - Wednesday 5. Weak ? day 2 - - Wednesday 6. Non-ambulatory (unusual) ? day 2 - - Wednesday 7. Two emergency service ambulance assessment ? day 2 - - Wednesday 8. Symptoms improved ? day 3  - Thursday 9. Ambulatory  - day 3 - Thursday 10. Symptoms worsened ? day 4 - Friday 11. Chills ? day 4 - Friday 12. Non-ambulatory again ? day 4 - Friday 13. Fever 102.0 ? day 4 - Friday 14. Left side flank pain ? day 4 - Friday 15. CPR and declared decease at home by paramedics - day 5 - Saturday morning @ 1:32am"
	"1063522-1"	"1063522-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"1. Fatigue ? day 1 - Tuesday 2. Loss of appetite ? day 1 Tuesday 3. Fever 102.0 ? day 2 - Wednesday 4. Chills ? day 2 - - Wednesday 5. Weak ? day 2 - - Wednesday 6. Non-ambulatory (unusual) ? day 2 - - Wednesday 7. Two emergency service ambulance assessment ? day 2 - - Wednesday 8. Symptoms improved ? day 3  - Thursday 9. Ambulatory  - day 3 - Thursday 10. Symptoms worsened ? day 4 - Friday 11. Chills ? day 4 - Friday 12. Non-ambulatory again ? day 4 - Friday 13. Fever 102.0 ? day 4 - Friday 14. Left side flank pain ? day 4 - Friday 15. CPR and declared decease at home by paramedics - day 5 - Saturday morning @ 1:32am"
	"1063522-1"	"1063522-1"	"DECREASED APPETITE"	"10061428"	"65-79 years"	"65-79"	"1. Fatigue ? day 1 - Tuesday 2. Loss of appetite ? day 1 Tuesday 3. Fever 102.0 ? day 2 - Wednesday 4. Chills ? day 2 - - Wednesday 5. Weak ? day 2 - - Wednesday 6. Non-ambulatory (unusual) ? day 2 - - Wednesday 7. Two emergency service ambulance assessment ? day 2 - - Wednesday 8. Symptoms improved ? day 3  - Thursday 9. Ambulatory  - day 3 - Thursday 10. Symptoms worsened ? day 4 - Friday 11. Chills ? day 4 - Friday 12. Non-ambulatory again ? day 4 - Friday 13. Fever 102.0 ? day 4 - Friday 14. Left side flank pain ? day 4 - Friday 15. CPR and declared decease at home by paramedics - day 5 - Saturday morning @ 1:32am"
	"1063522-1"	"1063522-1"	"ELECTROCARDIOGRAM"	"10014362"	"65-79 years"	"65-79"	"1. Fatigue ? day 1 - Tuesday 2. Loss of appetite ? day 1 Tuesday 3. Fever 102.0 ? day 2 - Wednesday 4. Chills ? day 2 - - Wednesday 5. Weak ? day 2 - - Wednesday 6. Non-ambulatory (unusual) ? day 2 - - Wednesday 7. Two emergency service ambulance assessment ? day 2 - - Wednesday 8. Symptoms improved ? day 3  - Thursday 9. Ambulatory  - day 3 - Thursday 10. Symptoms worsened ? day 4 - Friday 11. Chills ? day 4 - Friday 12. Non-ambulatory again ? day 4 - Friday 13. Fever 102.0 ? day 4 - Friday 14. Left side flank pain ? day 4 - Friday 15. CPR and declared decease at home by paramedics - day 5 - Saturday morning @ 1:32am"
	"1063522-1"	"1063522-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"1. Fatigue ? day 1 - Tuesday 2. Loss of appetite ? day 1 Tuesday 3. Fever 102.0 ? day 2 - Wednesday 4. Chills ? day 2 - - Wednesday 5. Weak ? day 2 - - Wednesday 6. Non-ambulatory (unusual) ? day 2 - - Wednesday 7. Two emergency service ambulance assessment ? day 2 - - Wednesday 8. Symptoms improved ? day 3  - Thursday 9. Ambulatory  - day 3 - Thursday 10. Symptoms worsened ? day 4 - Friday 11. Chills ? day 4 - Friday 12. Non-ambulatory again ? day 4 - Friday 13. Fever 102.0 ? day 4 - Friday 14. Left side flank pain ? day 4 - Friday 15. CPR and declared decease at home by paramedics - day 5 - Saturday morning @ 1:32am"
	"1063522-1"	"1063522-1"	"FLANK PAIN"	"10016750"	"65-79 years"	"65-79"	"1. Fatigue ? day 1 - Tuesday 2. Loss of appetite ? day 1 Tuesday 3. Fever 102.0 ? day 2 - Wednesday 4. Chills ? day 2 - - Wednesday 5. Weak ? day 2 - - Wednesday 6. Non-ambulatory (unusual) ? day 2 - - Wednesday 7. Two emergency service ambulance assessment ? day 2 - - Wednesday 8. Symptoms improved ? day 3  - Thursday 9. Ambulatory  - day 3 - Thursday 10. Symptoms worsened ? day 4 - Friday 11. Chills ? day 4 - Friday 12. Non-ambulatory again ? day 4 - Friday 13. Fever 102.0 ? day 4 - Friday 14. Left side flank pain ? day 4 - Friday 15. CPR and declared decease at home by paramedics - day 5 - Saturday morning @ 1:32am"
	"1063522-1"	"1063522-1"	"GAIT INABILITY"	"10017581"	"65-79 years"	"65-79"	"1. Fatigue ? day 1 - Tuesday 2. Loss of appetite ? day 1 Tuesday 3. Fever 102.0 ? day 2 - Wednesday 4. Chills ? day 2 - - Wednesday 5. Weak ? day 2 - - Wednesday 6. Non-ambulatory (unusual) ? day 2 - - Wednesday 7. Two emergency service ambulance assessment ? day 2 - - Wednesday 8. Symptoms improved ? day 3  - Thursday 9. Ambulatory  - day 3 - Thursday 10. Symptoms worsened ? day 4 - Friday 11. Chills ? day 4 - Friday 12. Non-ambulatory again ? day 4 - Friday 13. Fever 102.0 ? day 4 - Friday 14. Left side flank pain ? day 4 - Friday 15. CPR and declared decease at home by paramedics - day 5 - Saturday morning @ 1:32am"
	"1063522-1"	"1063522-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"1. Fatigue ? day 1 - Tuesday 2. Loss of appetite ? day 1 Tuesday 3. Fever 102.0 ? day 2 - Wednesday 4. Chills ? day 2 - - Wednesday 5. Weak ? day 2 - - Wednesday 6. Non-ambulatory (unusual) ? day 2 - - Wednesday 7. Two emergency service ambulance assessment ? day 2 - - Wednesday 8. Symptoms improved ? day 3  - Thursday 9. Ambulatory  - day 3 - Thursday 10. Symptoms worsened ? day 4 - Friday 11. Chills ? day 4 - Friday 12. Non-ambulatory again ? day 4 - Friday 13. Fever 102.0 ? day 4 - Friday 14. Left side flank pain ? day 4 - Friday 15. CPR and declared decease at home by paramedics - day 5 - Saturday morning @ 1:32am"
	"1063522-1"	"1063522-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"1. Fatigue ? day 1 - Tuesday 2. Loss of appetite ? day 1 Tuesday 3. Fever 102.0 ? day 2 - Wednesday 4. Chills ? day 2 - - Wednesday 5. Weak ? day 2 - - Wednesday 6. Non-ambulatory (unusual) ? day 2 - - Wednesday 7. Two emergency service ambulance assessment ? day 2 - - Wednesday 8. Symptoms improved ? day 3  - Thursday 9. Ambulatory  - day 3 - Thursday 10. Symptoms worsened ? day 4 - Friday 11. Chills ? day 4 - Friday 12. Non-ambulatory again ? day 4 - Friday 13. Fever 102.0 ? day 4 - Friday 14. Left side flank pain ? day 4 - Friday 15. CPR and declared decease at home by paramedics - day 5 - Saturday morning @ 1:32am"
	"1063674-1"	"1063674-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"EMS responded to a call at his home; he was found unresponsive by family slumped over in a chair"
	"1063681-1"	"1063681-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt got his vaccine 1/27 and was found dead at his residence on 2/7/21.   I heard from our county health officer who talked to the coroner who said that they estimated that the patient had been deceased for 2-3 days prior to when they were found. No apparent cause of death was found."
	"1063727-1"	"1063727-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Called pt for Dose 2 appt. Pt had passed away."
	"1066484-1"	"1066484-1"	"CARDIAC DISORDER"	"10061024"	"65-79 years"	"65-79"	"Received vaccination at 14:20 2/26/21. Was observed until discharged at 15:15. Discharged per wheel chair to lobby in alert/stable condition, to wait on bus to take him home. At 18:00 his neighbor heard him fall, could not get patient to answer phone, found him unresponsive. Neighbor called 9-1-1, ambulance personnel could not revive patient.  Coroner's office ruled his death as Natural Causes due to Hypertension, Cardiac disease, Diabetes, ESRD.  There were no indication of anaphylactic reaction noted when I questioned the coroner's office. The Coroner's office/EMS were aware the patient had received the Moderna COVID 19 vaccination that day."
	"1066484-1"	"1066484-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Received vaccination at 14:20 2/26/21. Was observed until discharged at 15:15. Discharged per wheel chair to lobby in alert/stable condition, to wait on bus to take him home. At 18:00 his neighbor heard him fall, could not get patient to answer phone, found him unresponsive. Neighbor called 9-1-1, ambulance personnel could not revive patient.  Coroner's office ruled his death as Natural Causes due to Hypertension, Cardiac disease, Diabetes, ESRD.  There were no indication of anaphylactic reaction noted when I questioned the coroner's office. The Coroner's office/EMS were aware the patient had received the Moderna COVID 19 vaccination that day."
	"1066484-1"	"1066484-1"	"DIABETES MELLITUS"	"10012601"	"65-79 years"	"65-79"	"Received vaccination at 14:20 2/26/21. Was observed until discharged at 15:15. Discharged per wheel chair to lobby in alert/stable condition, to wait on bus to take him home. At 18:00 his neighbor heard him fall, could not get patient to answer phone, found him unresponsive. Neighbor called 9-1-1, ambulance personnel could not revive patient.  Coroner's office ruled his death as Natural Causes due to Hypertension, Cardiac disease, Diabetes, ESRD.  There were no indication of anaphylactic reaction noted when I questioned the coroner's office. The Coroner's office/EMS were aware the patient had received the Moderna COVID 19 vaccination that day."
	"1066484-1"	"1066484-1"	"END STAGE RENAL DISEASE"	"10077512"	"65-79 years"	"65-79"	"Received vaccination at 14:20 2/26/21. Was observed until discharged at 15:15. Discharged per wheel chair to lobby in alert/stable condition, to wait on bus to take him home. At 18:00 his neighbor heard him fall, could not get patient to answer phone, found him unresponsive. Neighbor called 9-1-1, ambulance personnel could not revive patient.  Coroner's office ruled his death as Natural Causes due to Hypertension, Cardiac disease, Diabetes, ESRD.  There were no indication of anaphylactic reaction noted when I questioned the coroner's office. The Coroner's office/EMS were aware the patient had received the Moderna COVID 19 vaccination that day."
	"1066484-1"	"1066484-1"	"FALL"	"10016173"	"65-79 years"	"65-79"	"Received vaccination at 14:20 2/26/21. Was observed until discharged at 15:15. Discharged per wheel chair to lobby in alert/stable condition, to wait on bus to take him home. At 18:00 his neighbor heard him fall, could not get patient to answer phone, found him unresponsive. Neighbor called 9-1-1, ambulance personnel could not revive patient.  Coroner's office ruled his death as Natural Causes due to Hypertension, Cardiac disease, Diabetes, ESRD.  There were no indication of anaphylactic reaction noted when I questioned the coroner's office. The Coroner's office/EMS were aware the patient had received the Moderna COVID 19 vaccination that day."
	"1066484-1"	"1066484-1"	"HYPERTENSION"	"10020772"	"65-79 years"	"65-79"	"Received vaccination at 14:20 2/26/21. Was observed until discharged at 15:15. Discharged per wheel chair to lobby in alert/stable condition, to wait on bus to take him home. At 18:00 his neighbor heard him fall, could not get patient to answer phone, found him unresponsive. Neighbor called 9-1-1, ambulance personnel could not revive patient.  Coroner's office ruled his death as Natural Causes due to Hypertension, Cardiac disease, Diabetes, ESRD.  There were no indication of anaphylactic reaction noted when I questioned the coroner's office. The Coroner's office/EMS were aware the patient had received the Moderna COVID 19 vaccination that day."
	"1066484-1"	"1066484-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"Received vaccination at 14:20 2/26/21. Was observed until discharged at 15:15. Discharged per wheel chair to lobby in alert/stable condition, to wait on bus to take him home. At 18:00 his neighbor heard him fall, could not get patient to answer phone, found him unresponsive. Neighbor called 9-1-1, ambulance personnel could not revive patient.  Coroner's office ruled his death as Natural Causes due to Hypertension, Cardiac disease, Diabetes, ESRD.  There were no indication of anaphylactic reaction noted when I questioned the coroner's office. The Coroner's office/EMS were aware the patient had received the Moderna COVID 19 vaccination that day."
	"1068308-1"	"1068308-1"	"ABDOMINAL DISCOMFORT"	"10000059"	"65-79 years"	"65-79"	"cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion; On 21Feb he went to the ER after vomiting and passing out; On 21Feb he went to the ER after vomiting and passing out; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; fever; headache; stomach upset; This is a spontaneous report from a contactable consumer reporting for the father:  A 75-year-old male patient received the 1st dose of bnt162b2 (BNT162B2, Lot # EL3428) at single dose at left arm on 03Feb2021 for Covid-19 immunisation. Medical history included type 2 diabetes mellitus. No known allergies. The patient had not experienced Covid-19 prior vaccination. Concomitant medication in 2 weeks included amitriptyline hydrochloride (manufacturer unknown) 10 mg, atorvastatin (manufacturer unknown) 20 mg, dutasteride (manufacturer unknown) 0.5 mg, linaclotide (LINZESS) 290 mcg, gabapentin (manufacturer unknown) 300 mg, montelukast (manufacturer unknown) 10 mg, ramipril (manufacturer unknown) 5 mg, insulin degludec (TRESIBA) 100 unit/ml, liraglutide (VICTOZA) 18 mg/3ml solution. No other vaccine in 4 weeks. The patient experienced cardiac arrest due to pericardial effusion on 21Feb2021 14:15, fever on 13Feb2021, headache on 13Feb2021, stomach upset on 13Feb2021, on 19feb, he began to feel ill again with a fever, he felt worse on 20feb on 19Feb2021, on 21feb he went to the ER after vomiting and passing out on 21Feb2021.  Events resulted in Emergency room/department or urgent care. Therapeutic measures were taken as a result of cardiac arrest due to pericardial effusion.  Course of events: In Feb2021, 10 days after his 1st injection, the patient developed fever, headache, and stomach upset. He went for a rapid Covid-19 test (nasal swab) and it was negative on 11Feb2021. The doctor told him he might be having a delayed reaction to the vaccination. After a couple of days, he improved. On 19Feb2021, he began to feel ill again with a fever. He felt worse on 20Feb2021. On 21Feb2021 he went to the ER after vomiting and passing out and received treatment: IV fluids, diagnostic testing at ER. Rapid Covid test (nasal swab) at ER came back negative again on 21Feb2021. His heart arrested suddenly and he could not be resuscitated. CT scan results, that came back after death, showed Covid like pneumonia and pericardial effusion. The patient died on 21Feb2021 14:15. Cause of death was cardiac arrest due to pericardial effusion. An autopsy was not performed. The outcome of cardiac arrest due to pericardial effusion was fatal, of fever, headache, stomach upset was recovering, of he began to feel ill again with a fever, he felt worse was not recovered, of he went to the ER after vomiting and passing out was unknown.; Reported Cause(s) of Death: cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion"
	"1068308-1"	"1068308-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion; On 21Feb he went to the ER after vomiting and passing out; On 21Feb he went to the ER after vomiting and passing out; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; fever; headache; stomach upset; This is a spontaneous report from a contactable consumer reporting for the father:  A 75-year-old male patient received the 1st dose of bnt162b2 (BNT162B2, Lot # EL3428) at single dose at left arm on 03Feb2021 for Covid-19 immunisation. Medical history included type 2 diabetes mellitus. No known allergies. The patient had not experienced Covid-19 prior vaccination. Concomitant medication in 2 weeks included amitriptyline hydrochloride (manufacturer unknown) 10 mg, atorvastatin (manufacturer unknown) 20 mg, dutasteride (manufacturer unknown) 0.5 mg, linaclotide (LINZESS) 290 mcg, gabapentin (manufacturer unknown) 300 mg, montelukast (manufacturer unknown) 10 mg, ramipril (manufacturer unknown) 5 mg, insulin degludec (TRESIBA) 100 unit/ml, liraglutide (VICTOZA) 18 mg/3ml solution. No other vaccine in 4 weeks. The patient experienced cardiac arrest due to pericardial effusion on 21Feb2021 14:15, fever on 13Feb2021, headache on 13Feb2021, stomach upset on 13Feb2021, on 19feb, he began to feel ill again with a fever, he felt worse on 20feb on 19Feb2021, on 21feb he went to the ER after vomiting and passing out on 21Feb2021.  Events resulted in Emergency room/department or urgent care. Therapeutic measures were taken as a result of cardiac arrest due to pericardial effusion.  Course of events: In Feb2021, 10 days after his 1st injection, the patient developed fever, headache, and stomach upset. He went for a rapid Covid-19 test (nasal swab) and it was negative on 11Feb2021. The doctor told him he might be having a delayed reaction to the vaccination. After a couple of days, he improved. On 19Feb2021, he began to feel ill again with a fever. He felt worse on 20Feb2021. On 21Feb2021 he went to the ER after vomiting and passing out and received treatment: IV fluids, diagnostic testing at ER. Rapid Covid test (nasal swab) at ER came back negative again on 21Feb2021. His heart arrested suddenly and he could not be resuscitated. CT scan results, that came back after death, showed Covid like pneumonia and pericardial effusion. The patient died on 21Feb2021 14:15. Cause of death was cardiac arrest due to pericardial effusion. An autopsy was not performed. The outcome of cardiac arrest due to pericardial effusion was fatal, of fever, headache, stomach upset was recovering, of he began to feel ill again with a fever, he felt worse was not recovered, of he went to the ER after vomiting and passing out was unknown.; Reported Cause(s) of Death: cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion"
	"1068308-1"	"1068308-1"	"COMPUTERISED TOMOGRAM"	"10010234"	"65-79 years"	"65-79"	"cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion; On 21Feb he went to the ER after vomiting and passing out; On 21Feb he went to the ER after vomiting and passing out; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; fever; headache; stomach upset; This is a spontaneous report from a contactable consumer reporting for the father:  A 75-year-old male patient received the 1st dose of bnt162b2 (BNT162B2, Lot # EL3428) at single dose at left arm on 03Feb2021 for Covid-19 immunisation. Medical history included type 2 diabetes mellitus. No known allergies. The patient had not experienced Covid-19 prior vaccination. Concomitant medication in 2 weeks included amitriptyline hydrochloride (manufacturer unknown) 10 mg, atorvastatin (manufacturer unknown) 20 mg, dutasteride (manufacturer unknown) 0.5 mg, linaclotide (LINZESS) 290 mcg, gabapentin (manufacturer unknown) 300 mg, montelukast (manufacturer unknown) 10 mg, ramipril (manufacturer unknown) 5 mg, insulin degludec (TRESIBA) 100 unit/ml, liraglutide (VICTOZA) 18 mg/3ml solution. No other vaccine in 4 weeks. The patient experienced cardiac arrest due to pericardial effusion on 21Feb2021 14:15, fever on 13Feb2021, headache on 13Feb2021, stomach upset on 13Feb2021, on 19feb, he began to feel ill again with a fever, he felt worse on 20feb on 19Feb2021, on 21feb he went to the ER after vomiting and passing out on 21Feb2021.  Events resulted in Emergency room/department or urgent care. Therapeutic measures were taken as a result of cardiac arrest due to pericardial effusion.  Course of events: In Feb2021, 10 days after his 1st injection, the patient developed fever, headache, and stomach upset. He went for a rapid Covid-19 test (nasal swab) and it was negative on 11Feb2021. The doctor told him he might be having a delayed reaction to the vaccination. After a couple of days, he improved. On 19Feb2021, he began to feel ill again with a fever. He felt worse on 20Feb2021. On 21Feb2021 he went to the ER after vomiting and passing out and received treatment: IV fluids, diagnostic testing at ER. Rapid Covid test (nasal swab) at ER came back negative again on 21Feb2021. His heart arrested suddenly and he could not be resuscitated. CT scan results, that came back after death, showed Covid like pneumonia and pericardial effusion. The patient died on 21Feb2021 14:15. Cause of death was cardiac arrest due to pericardial effusion. An autopsy was not performed. The outcome of cardiac arrest due to pericardial effusion was fatal, of fever, headache, stomach upset was recovering, of he began to feel ill again with a fever, he felt worse was not recovered, of he went to the ER after vomiting and passing out was unknown.; Reported Cause(s) of Death: cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion"
	"1068308-1"	"1068308-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion; On 21Feb he went to the ER after vomiting and passing out; On 21Feb he went to the ER after vomiting and passing out; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; fever; headache; stomach upset; This is a spontaneous report from a contactable consumer reporting for the father:  A 75-year-old male patient received the 1st dose of bnt162b2 (BNT162B2, Lot # EL3428) at single dose at left arm on 03Feb2021 for Covid-19 immunisation. Medical history included type 2 diabetes mellitus. No known allergies. The patient had not experienced Covid-19 prior vaccination. Concomitant medication in 2 weeks included amitriptyline hydrochloride (manufacturer unknown) 10 mg, atorvastatin (manufacturer unknown) 20 mg, dutasteride (manufacturer unknown) 0.5 mg, linaclotide (LINZESS) 290 mcg, gabapentin (manufacturer unknown) 300 mg, montelukast (manufacturer unknown) 10 mg, ramipril (manufacturer unknown) 5 mg, insulin degludec (TRESIBA) 100 unit/ml, liraglutide (VICTOZA) 18 mg/3ml solution. No other vaccine in 4 weeks. The patient experienced cardiac arrest due to pericardial effusion on 21Feb2021 14:15, fever on 13Feb2021, headache on 13Feb2021, stomach upset on 13Feb2021, on 19feb, he began to feel ill again with a fever, he felt worse on 20feb on 19Feb2021, on 21feb he went to the ER after vomiting and passing out on 21Feb2021.  Events resulted in Emergency room/department or urgent care. Therapeutic measures were taken as a result of cardiac arrest due to pericardial effusion.  Course of events: In Feb2021, 10 days after his 1st injection, the patient developed fever, headache, and stomach upset. He went for a rapid Covid-19 test (nasal swab) and it was negative on 11Feb2021. The doctor told him he might be having a delayed reaction to the vaccination. After a couple of days, he improved. On 19Feb2021, he began to feel ill again with a fever. He felt worse on 20Feb2021. On 21Feb2021 he went to the ER after vomiting and passing out and received treatment: IV fluids, diagnostic testing at ER. Rapid Covid test (nasal swab) at ER came back negative again on 21Feb2021. His heart arrested suddenly and he could not be resuscitated. CT scan results, that came back after death, showed Covid like pneumonia and pericardial effusion. The patient died on 21Feb2021 14:15. Cause of death was cardiac arrest due to pericardial effusion. An autopsy was not performed. The outcome of cardiac arrest due to pericardial effusion was fatal, of fever, headache, stomach upset was recovering, of he began to feel ill again with a fever, he felt worse was not recovered, of he went to the ER after vomiting and passing out was unknown.; Reported Cause(s) of Death: cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion"
	"1068308-1"	"1068308-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	"cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion; On 21Feb he went to the ER after vomiting and passing out; On 21Feb he went to the ER after vomiting and passing out; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; fever; headache; stomach upset; This is a spontaneous report from a contactable consumer reporting for the father:  A 75-year-old male patient received the 1st dose of bnt162b2 (BNT162B2, Lot # EL3428) at single dose at left arm on 03Feb2021 for Covid-19 immunisation. Medical history included type 2 diabetes mellitus. No known allergies. The patient had not experienced Covid-19 prior vaccination. Concomitant medication in 2 weeks included amitriptyline hydrochloride (manufacturer unknown) 10 mg, atorvastatin (manufacturer unknown) 20 mg, dutasteride (manufacturer unknown) 0.5 mg, linaclotide (LINZESS) 290 mcg, gabapentin (manufacturer unknown) 300 mg, montelukast (manufacturer unknown) 10 mg, ramipril (manufacturer unknown) 5 mg, insulin degludec (TRESIBA) 100 unit/ml, liraglutide (VICTOZA) 18 mg/3ml solution. No other vaccine in 4 weeks. The patient experienced cardiac arrest due to pericardial effusion on 21Feb2021 14:15, fever on 13Feb2021, headache on 13Feb2021, stomach upset on 13Feb2021, on 19feb, he began to feel ill again with a fever, he felt worse on 20feb on 19Feb2021, on 21feb he went to the ER after vomiting and passing out on 21Feb2021.  Events resulted in Emergency room/department or urgent care. Therapeutic measures were taken as a result of cardiac arrest due to pericardial effusion.  Course of events: In Feb2021, 10 days after his 1st injection, the patient developed fever, headache, and stomach upset. He went for a rapid Covid-19 test (nasal swab) and it was negative on 11Feb2021. The doctor told him he might be having a delayed reaction to the vaccination. After a couple of days, he improved. On 19Feb2021, he began to feel ill again with a fever. He felt worse on 20Feb2021. On 21Feb2021 he went to the ER after vomiting and passing out and received treatment: IV fluids, diagnostic testing at ER. Rapid Covid test (nasal swab) at ER came back negative again on 21Feb2021. His heart arrested suddenly and he could not be resuscitated. CT scan results, that came back after death, showed Covid like pneumonia and pericardial effusion. The patient died on 21Feb2021 14:15. Cause of death was cardiac arrest due to pericardial effusion. An autopsy was not performed. The outcome of cardiac arrest due to pericardial effusion was fatal, of fever, headache, stomach upset was recovering, of he began to feel ill again with a fever, he felt worse was not recovered, of he went to the ER after vomiting and passing out was unknown.; Reported Cause(s) of Death: cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion"
	"1068308-1"	"1068308-1"	"LOSS OF CONSCIOUSNESS"	"10024855"	"65-79 years"	"65-79"	"cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion; On 21Feb he went to the ER after vomiting and passing out; On 21Feb he went to the ER after vomiting and passing out; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; fever; headache; stomach upset; This is a spontaneous report from a contactable consumer reporting for the father:  A 75-year-old male patient received the 1st dose of bnt162b2 (BNT162B2, Lot # EL3428) at single dose at left arm on 03Feb2021 for Covid-19 immunisation. Medical history included type 2 diabetes mellitus. No known allergies. The patient had not experienced Covid-19 prior vaccination. Concomitant medication in 2 weeks included amitriptyline hydrochloride (manufacturer unknown) 10 mg, atorvastatin (manufacturer unknown) 20 mg, dutasteride (manufacturer unknown) 0.5 mg, linaclotide (LINZESS) 290 mcg, gabapentin (manufacturer unknown) 300 mg, montelukast (manufacturer unknown) 10 mg, ramipril (manufacturer unknown) 5 mg, insulin degludec (TRESIBA) 100 unit/ml, liraglutide (VICTOZA) 18 mg/3ml solution. No other vaccine in 4 weeks. The patient experienced cardiac arrest due to pericardial effusion on 21Feb2021 14:15, fever on 13Feb2021, headache on 13Feb2021, stomach upset on 13Feb2021, on 19feb, he began to feel ill again with a fever, he felt worse on 20feb on 19Feb2021, on 21feb he went to the ER after vomiting and passing out on 21Feb2021.  Events resulted in Emergency room/department or urgent care. Therapeutic measures were taken as a result of cardiac arrest due to pericardial effusion.  Course of events: In Feb2021, 10 days after his 1st injection, the patient developed fever, headache, and stomach upset. He went for a rapid Covid-19 test (nasal swab) and it was negative on 11Feb2021. The doctor told him he might be having a delayed reaction to the vaccination. After a couple of days, he improved. On 19Feb2021, he began to feel ill again with a fever. He felt worse on 20Feb2021. On 21Feb2021 he went to the ER after vomiting and passing out and received treatment: IV fluids, diagnostic testing at ER. Rapid Covid test (nasal swab) at ER came back negative again on 21Feb2021. His heart arrested suddenly and he could not be resuscitated. CT scan results, that came back after death, showed Covid like pneumonia and pericardial effusion. The patient died on 21Feb2021 14:15. Cause of death was cardiac arrest due to pericardial effusion. An autopsy was not performed. The outcome of cardiac arrest due to pericardial effusion was fatal, of fever, headache, stomach upset was recovering, of he began to feel ill again with a fever, he felt worse was not recovered, of he went to the ER after vomiting and passing out was unknown.; Reported Cause(s) of Death: cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion"
	"1068308-1"	"1068308-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion; On 21Feb he went to the ER after vomiting and passing out; On 21Feb he went to the ER after vomiting and passing out; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; fever; headache; stomach upset; This is a spontaneous report from a contactable consumer reporting for the father:  A 75-year-old male patient received the 1st dose of bnt162b2 (BNT162B2, Lot # EL3428) at single dose at left arm on 03Feb2021 for Covid-19 immunisation. Medical history included type 2 diabetes mellitus. No known allergies. The patient had not experienced Covid-19 prior vaccination. Concomitant medication in 2 weeks included amitriptyline hydrochloride (manufacturer unknown) 10 mg, atorvastatin (manufacturer unknown) 20 mg, dutasteride (manufacturer unknown) 0.5 mg, linaclotide (LINZESS) 290 mcg, gabapentin (manufacturer unknown) 300 mg, montelukast (manufacturer unknown) 10 mg, ramipril (manufacturer unknown) 5 mg, insulin degludec (TRESIBA) 100 unit/ml, liraglutide (VICTOZA) 18 mg/3ml solution. No other vaccine in 4 weeks. The patient experienced cardiac arrest due to pericardial effusion on 21Feb2021 14:15, fever on 13Feb2021, headache on 13Feb2021, stomach upset on 13Feb2021, on 19feb, he began to feel ill again with a fever, he felt worse on 20feb on 19Feb2021, on 21feb he went to the ER after vomiting and passing out on 21Feb2021.  Events resulted in Emergency room/department or urgent care. Therapeutic measures were taken as a result of cardiac arrest due to pericardial effusion.  Course of events: In Feb2021, 10 days after his 1st injection, the patient developed fever, headache, and stomach upset. He went for a rapid Covid-19 test (nasal swab) and it was negative on 11Feb2021. The doctor told him he might be having a delayed reaction to the vaccination. After a couple of days, he improved. On 19Feb2021, he began to feel ill again with a fever. He felt worse on 20Feb2021. On 21Feb2021 he went to the ER after vomiting and passing out and received treatment: IV fluids, diagnostic testing at ER. Rapid Covid test (nasal swab) at ER came back negative again on 21Feb2021. His heart arrested suddenly and he could not be resuscitated. CT scan results, that came back after death, showed Covid like pneumonia and pericardial effusion. The patient died on 21Feb2021 14:15. Cause of death was cardiac arrest due to pericardial effusion. An autopsy was not performed. The outcome of cardiac arrest due to pericardial effusion was fatal, of fever, headache, stomach upset was recovering, of he began to feel ill again with a fever, he felt worse was not recovered, of he went to the ER after vomiting and passing out was unknown.; Reported Cause(s) of Death: cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion"
	"1068308-1"	"1068308-1"	"PERICARDIAL EFFUSION"	"10034474"	"65-79 years"	"65-79"	"cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion; On 21Feb he went to the ER after vomiting and passing out; On 21Feb he went to the ER after vomiting and passing out; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; fever; headache; stomach upset; This is a spontaneous report from a contactable consumer reporting for the father:  A 75-year-old male patient received the 1st dose of bnt162b2 (BNT162B2, Lot # EL3428) at single dose at left arm on 03Feb2021 for Covid-19 immunisation. Medical history included type 2 diabetes mellitus. No known allergies. The patient had not experienced Covid-19 prior vaccination. Concomitant medication in 2 weeks included amitriptyline hydrochloride (manufacturer unknown) 10 mg, atorvastatin (manufacturer unknown) 20 mg, dutasteride (manufacturer unknown) 0.5 mg, linaclotide (LINZESS) 290 mcg, gabapentin (manufacturer unknown) 300 mg, montelukast (manufacturer unknown) 10 mg, ramipril (manufacturer unknown) 5 mg, insulin degludec (TRESIBA) 100 unit/ml, liraglutide (VICTOZA) 18 mg/3ml solution. No other vaccine in 4 weeks. The patient experienced cardiac arrest due to pericardial effusion on 21Feb2021 14:15, fever on 13Feb2021, headache on 13Feb2021, stomach upset on 13Feb2021, on 19feb, he began to feel ill again with a fever, he felt worse on 20feb on 19Feb2021, on 21feb he went to the ER after vomiting and passing out on 21Feb2021.  Events resulted in Emergency room/department or urgent care. Therapeutic measures were taken as a result of cardiac arrest due to pericardial effusion.  Course of events: In Feb2021, 10 days after his 1st injection, the patient developed fever, headache, and stomach upset. He went for a rapid Covid-19 test (nasal swab) and it was negative on 11Feb2021. The doctor told him he might be having a delayed reaction to the vaccination. After a couple of days, he improved. On 19Feb2021, he began to feel ill again with a fever. He felt worse on 20Feb2021. On 21Feb2021 he went to the ER after vomiting and passing out and received treatment: IV fluids, diagnostic testing at ER. Rapid Covid test (nasal swab) at ER came back negative again on 21Feb2021. His heart arrested suddenly and he could not be resuscitated. CT scan results, that came back after death, showed Covid like pneumonia and pericardial effusion. The patient died on 21Feb2021 14:15. Cause of death was cardiac arrest due to pericardial effusion. An autopsy was not performed. The outcome of cardiac arrest due to pericardial effusion was fatal, of fever, headache, stomach upset was recovering, of he began to feel ill again with a fever, he felt worse was not recovered, of he went to the ER after vomiting and passing out was unknown.; Reported Cause(s) of Death: cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion"
	"1068308-1"	"1068308-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion; On 21Feb he went to the ER after vomiting and passing out; On 21Feb he went to the ER after vomiting and passing out; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; fever; headache; stomach upset; This is a spontaneous report from a contactable consumer reporting for the father:  A 75-year-old male patient received the 1st dose of bnt162b2 (BNT162B2, Lot # EL3428) at single dose at left arm on 03Feb2021 for Covid-19 immunisation. Medical history included type 2 diabetes mellitus. No known allergies. The patient had not experienced Covid-19 prior vaccination. Concomitant medication in 2 weeks included amitriptyline hydrochloride (manufacturer unknown) 10 mg, atorvastatin (manufacturer unknown) 20 mg, dutasteride (manufacturer unknown) 0.5 mg, linaclotide (LINZESS) 290 mcg, gabapentin (manufacturer unknown) 300 mg, montelukast (manufacturer unknown) 10 mg, ramipril (manufacturer unknown) 5 mg, insulin degludec (TRESIBA) 100 unit/ml, liraglutide (VICTOZA) 18 mg/3ml solution. No other vaccine in 4 weeks. The patient experienced cardiac arrest due to pericardial effusion on 21Feb2021 14:15, fever on 13Feb2021, headache on 13Feb2021, stomach upset on 13Feb2021, on 19feb, he began to feel ill again with a fever, he felt worse on 20feb on 19Feb2021, on 21feb he went to the ER after vomiting and passing out on 21Feb2021.  Events resulted in Emergency room/department or urgent care. Therapeutic measures were taken as a result of cardiac arrest due to pericardial effusion.  Course of events: In Feb2021, 10 days after his 1st injection, the patient developed fever, headache, and stomach upset. He went for a rapid Covid-19 test (nasal swab) and it was negative on 11Feb2021. The doctor told him he might be having a delayed reaction to the vaccination. After a couple of days, he improved. On 19Feb2021, he began to feel ill again with a fever. He felt worse on 20Feb2021. On 21Feb2021 he went to the ER after vomiting and passing out and received treatment: IV fluids, diagnostic testing at ER. Rapid Covid test (nasal swab) at ER came back negative again on 21Feb2021. His heart arrested suddenly and he could not be resuscitated. CT scan results, that came back after death, showed Covid like pneumonia and pericardial effusion. The patient died on 21Feb2021 14:15. Cause of death was cardiac arrest due to pericardial effusion. An autopsy was not performed. The outcome of cardiac arrest due to pericardial effusion was fatal, of fever, headache, stomach upset was recovering, of he began to feel ill again with a fever, he felt worse was not recovered, of he went to the ER after vomiting and passing out was unknown.; Reported Cause(s) of Death: cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion"
	"1068308-1"	"1068308-1"	"SARS-COV-2 ANTIBODY TEST"	"10084501"	"65-79 years"	"65-79"	"cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion; On 21Feb he went to the ER after vomiting and passing out; On 21Feb he went to the ER after vomiting and passing out; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; fever; headache; stomach upset; This is a spontaneous report from a contactable consumer reporting for the father:  A 75-year-old male patient received the 1st dose of bnt162b2 (BNT162B2, Lot # EL3428) at single dose at left arm on 03Feb2021 for Covid-19 immunisation. Medical history included type 2 diabetes mellitus. No known allergies. The patient had not experienced Covid-19 prior vaccination. Concomitant medication in 2 weeks included amitriptyline hydrochloride (manufacturer unknown) 10 mg, atorvastatin (manufacturer unknown) 20 mg, dutasteride (manufacturer unknown) 0.5 mg, linaclotide (LINZESS) 290 mcg, gabapentin (manufacturer unknown) 300 mg, montelukast (manufacturer unknown) 10 mg, ramipril (manufacturer unknown) 5 mg, insulin degludec (TRESIBA) 100 unit/ml, liraglutide (VICTOZA) 18 mg/3ml solution. No other vaccine in 4 weeks. The patient experienced cardiac arrest due to pericardial effusion on 21Feb2021 14:15, fever on 13Feb2021, headache on 13Feb2021, stomach upset on 13Feb2021, on 19feb, he began to feel ill again with a fever, he felt worse on 20feb on 19Feb2021, on 21feb he went to the ER after vomiting and passing out on 21Feb2021.  Events resulted in Emergency room/department or urgent care. Therapeutic measures were taken as a result of cardiac arrest due to pericardial effusion.  Course of events: In Feb2021, 10 days after his 1st injection, the patient developed fever, headache, and stomach upset. He went for a rapid Covid-19 test (nasal swab) and it was negative on 11Feb2021. The doctor told him he might be having a delayed reaction to the vaccination. After a couple of days, he improved. On 19Feb2021, he began to feel ill again with a fever. He felt worse on 20Feb2021. On 21Feb2021 he went to the ER after vomiting and passing out and received treatment: IV fluids, diagnostic testing at ER. Rapid Covid test (nasal swab) at ER came back negative again on 21Feb2021. His heart arrested suddenly and he could not be resuscitated. CT scan results, that came back after death, showed Covid like pneumonia and pericardial effusion. The patient died on 21Feb2021 14:15. Cause of death was cardiac arrest due to pericardial effusion. An autopsy was not performed. The outcome of cardiac arrest due to pericardial effusion was fatal, of fever, headache, stomach upset was recovering, of he began to feel ill again with a fever, he felt worse was not recovered, of he went to the ER after vomiting and passing out was unknown.; Reported Cause(s) of Death: cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion"
	"1068308-1"	"1068308-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion; On 21Feb he went to the ER after vomiting and passing out; On 21Feb he went to the ER after vomiting and passing out; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; On 19Feb, he began to feel ill again with a fever. He felt worse on 20Feb; fever; headache; stomach upset; This is a spontaneous report from a contactable consumer reporting for the father:  A 75-year-old male patient received the 1st dose of bnt162b2 (BNT162B2, Lot # EL3428) at single dose at left arm on 03Feb2021 for Covid-19 immunisation. Medical history included type 2 diabetes mellitus. No known allergies. The patient had not experienced Covid-19 prior vaccination. Concomitant medication in 2 weeks included amitriptyline hydrochloride (manufacturer unknown) 10 mg, atorvastatin (manufacturer unknown) 20 mg, dutasteride (manufacturer unknown) 0.5 mg, linaclotide (LINZESS) 290 mcg, gabapentin (manufacturer unknown) 300 mg, montelukast (manufacturer unknown) 10 mg, ramipril (manufacturer unknown) 5 mg, insulin degludec (TRESIBA) 100 unit/ml, liraglutide (VICTOZA) 18 mg/3ml solution. No other vaccine in 4 weeks. The patient experienced cardiac arrest due to pericardial effusion on 21Feb2021 14:15, fever on 13Feb2021, headache on 13Feb2021, stomach upset on 13Feb2021, on 19feb, he began to feel ill again with a fever, he felt worse on 20feb on 19Feb2021, on 21feb he went to the ER after vomiting and passing out on 21Feb2021.  Events resulted in Emergency room/department or urgent care. Therapeutic measures were taken as a result of cardiac arrest due to pericardial effusion.  Course of events: In Feb2021, 10 days after his 1st injection, the patient developed fever, headache, and stomach upset. He went for a rapid Covid-19 test (nasal swab) and it was negative on 11Feb2021. The doctor told him he might be having a delayed reaction to the vaccination. After a couple of days, he improved. On 19Feb2021, he began to feel ill again with a fever. He felt worse on 20Feb2021. On 21Feb2021 he went to the ER after vomiting and passing out and received treatment: IV fluids, diagnostic testing at ER. Rapid Covid test (nasal swab) at ER came back negative again on 21Feb2021. His heart arrested suddenly and he could not be resuscitated. CT scan results, that came back after death, showed Covid like pneumonia and pericardial effusion. The patient died on 21Feb2021 14:15. Cause of death was cardiac arrest due to pericardial effusion. An autopsy was not performed. The outcome of cardiac arrest due to pericardial effusion was fatal, of fever, headache, stomach upset was recovering, of he began to feel ill again with a fever, he felt worse was not recovered, of he went to the ER after vomiting and passing out was unknown.; Reported Cause(s) of Death: cardiac arrest due to pericardial effusion; cardiac arrest due to pericardial effusion"
	"1068814-1"	"1068814-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"9 days after vaccination, the patient was found deceased in his home, sitting on his couch. Determined to be due to pulmonary embolism."
	"1068814-1"	"1068814-1"	"PULMONARY EMBOLISM"	"10037377"	"65-79 years"	"65-79"	"9 days after vaccination, the patient was found deceased in his home, sitting on his couch. Determined to be due to pulmonary embolism."
	"1068901-1"	"1068901-1"	"AORTIC DISSECTION"	"10002895"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"AORTITIS"	"10002921"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"ARTERITIS CORONARY"	"10003232"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"CARDIOVERSION"	"10007661"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"COMPUTERISED TOMOGRAM"	"10010234"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"COMPUTERISED TOMOGRAM NORMAL"	"10010236"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"ECHOCARDIOGRAM"	"10014113"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"ELECTROCARDIOGRAM"	"10014362"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"ELECTROCARDIOGRAM NORMAL"	"10014373"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"INFLAMMATION"	"10061218"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"LABORATORY TEST"	"10059938"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"PAIN IN JAW"	"10033433"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"PULSE ABSENT"	"10037469"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"RED BLOOD CELL SEDIMENTATION RATE NORMAL"	"10049408"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"RESPIRATORY ARREST"	"10038669"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1068901-1"	"1068901-1"	"SYNCOPE"	"10042772"	"65-79 years"	"65-79"	"ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working. Released from care on 2/19 with prednisone . Symptoms still present off and on. 2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left. 10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced. reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation"
	"1074067-1"	"1074067-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received Moderna COVID-19 vaccine on 2/25/2021.  Patient found dead by family the morning of 2/26/2021.   Family requested an autopsy."
	"1078239-1"	"1078239-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death. Ruptured myocardial infarction."
	"1078239-1"	"1078239-1"	"MYOCARDIAL RUPTURE"	"10028604"	"65-79 years"	"65-79"	"Death. Ruptured myocardial infarction."
	"1078246-1"	"1078246-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death. Ruptured myocardial infarct."
	"1078246-1"	"1078246-1"	"MYOCARDIAL RUPTURE"	"10028604"	"65-79 years"	"65-79"	"Death. Ruptured myocardial infarct."
	"1080716-1"	"1080716-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"On day three after vaccine administration patient expired.  quite an active man, no signs led up to his death until maybe a half hour prior to the event."
	"1081308-1"	"1081308-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Death 3 days afterards, undetermined cause at this time."
	"1081308-1"	"1081308-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death 3 days afterards, undetermined cause at this time."
	"1081308-1"	"1081308-1"	"LABORATORY TEST NORMAL"	"10054052"	"65-79 years"	"65-79"	"Death 3 days afterards, undetermined cause at this time."
	"1082850-1"	"1082850-1"	"COMPUTERISED TOMOGRAM ABDOMEN"	"10053876"	"65-79 years"	"65-79"	"pt became nauseated and vomiting 1 day after getting vaccine,  reported on Mon  2/22/21 but states was getting better,  received call from sister on 2/25/21 that pt could not get out of bed on own -  was sent to ER at that time"
	"1082850-1"	"1082850-1"	"COMPUTERISED TOMOGRAM HEAD"	"10054003"	"65-79 years"	"65-79"	"pt became nauseated and vomiting 1 day after getting vaccine,  reported on Mon  2/22/21 but states was getting better,  received call from sister on 2/25/21 that pt could not get out of bed on own -  was sent to ER at that time"
	"1082850-1"	"1082850-1"	"COMPUTERISED TOMOGRAM SPINE"	"10081777"	"65-79 years"	"65-79"	"pt became nauseated and vomiting 1 day after getting vaccine,  reported on Mon  2/22/21 but states was getting better,  received call from sister on 2/25/21 that pt could not get out of bed on own -  was sent to ER at that time"
	"1082850-1"	"1082850-1"	"ELECTROCARDIOGRAM"	"10014362"	"65-79 years"	"65-79"	"pt became nauseated and vomiting 1 day after getting vaccine,  reported on Mon  2/22/21 but states was getting better,  received call from sister on 2/25/21 that pt could not get out of bed on own -  was sent to ER at that time"
	"1082850-1"	"1082850-1"	"LABORATORY TEST"	"10059938"	"65-79 years"	"65-79"	"pt became nauseated and vomiting 1 day after getting vaccine,  reported on Mon  2/22/21 but states was getting better,  received call from sister on 2/25/21 that pt could not get out of bed on own -  was sent to ER at that time"
	"1082850-1"	"1082850-1"	"MOBILITY DECREASED"	"10048334"	"65-79 years"	"65-79"	"pt became nauseated and vomiting 1 day after getting vaccine,  reported on Mon  2/22/21 but states was getting better,  received call from sister on 2/25/21 that pt could not get out of bed on own -  was sent to ER at that time"
	"1082850-1"	"1082850-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"pt became nauseated and vomiting 1 day after getting vaccine,  reported on Mon  2/22/21 but states was getting better,  received call from sister on 2/25/21 that pt could not get out of bed on own -  was sent to ER at that time"
	"1082850-1"	"1082850-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"pt became nauseated and vomiting 1 day after getting vaccine,  reported on Mon  2/22/21 but states was getting better,  received call from sister on 2/25/21 that pt could not get out of bed on own -  was sent to ER at that time"
	"1082850-1"	"1082850-1"	"X-RAY LIMB"	"10061585"	"65-79 years"	"65-79"	"pt became nauseated and vomiting 1 day after getting vaccine,  reported on Mon  2/22/21 but states was getting better,  received call from sister on 2/25/21 that pt could not get out of bed on own -  was sent to ER at that time"
	"1087735-1"	"1087735-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"On 3/5/21 at approximately 0200 became congested suddenly.  Doctor was notified with N.O. Torsemide 20 mg tab via PEG-tube NOW, IM Rocephin 1 mg QD x7 days for possible aspiration, Chest X Ray, CBC/BMP in morning, and may suction resident if tolerated PRN. Received both Torsemide and the Rocephin and then deceased at 0350."
	"1087735-1"	"1087735-1"	"RESPIRATORY TRACT CONGESTION"	"10052251"	"65-79 years"	"65-79"	"On 3/5/21 at approximately 0200 became congested suddenly.  Doctor was notified with N.O. Torsemide 20 mg tab via PEG-tube NOW, IM Rocephin 1 mg QD x7 days for possible aspiration, Chest X Ray, CBC/BMP in morning, and may suction resident if tolerated PRN. Received both Torsemide and the Rocephin and then deceased at 0350."
	"1087735-1"	"1087735-1"	"WEIGHT INCREASED"	"10047899"	"65-79 years"	"65-79"	"On 3/5/21 at approximately 0200 became congested suddenly.  Doctor was notified with N.O. Torsemide 20 mg tab via PEG-tube NOW, IM Rocephin 1 mg QD x7 days for possible aspiration, Chest X Ray, CBC/BMP in morning, and may suction resident if tolerated PRN. Received both Torsemide and the Rocephin and then deceased at 0350."
	"1091337-1"	"1091337-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"This is a hospice patient.  She died on 2/13/2021 from her underlying medical conditions.  I just received notification of the death 3/11/2021 and am reporting this immediately."
	"1092110-1"	"1092110-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away within 60 days of receiving a COVID vaccine series"
	"1093666-1"	"1093666-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Client Passed away on 1/28/2021"
	"1093857-1"	"1093857-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"According to the patient's wife, the patient had flu like symptoms 2/11/2021.    Complaints:  Thirsty, sweaty  and seizure with no prior history.    Died at home.  Not sent to hospital.    Pronounced by coroner"
	"1093857-1"	"1093857-1"	"HYPERHIDROSIS"	"10020642"	"65-79 years"	"65-79"	"According to the patient's wife, the patient had flu like symptoms 2/11/2021.    Complaints:  Thirsty, sweaty  and seizure with no prior history.    Died at home.  Not sent to hospital.    Pronounced by coroner"
	"1093857-1"	"1093857-1"	"INFLUENZA LIKE ILLNESS"	"10022004"	"65-79 years"	"65-79"	"According to the patient's wife, the patient had flu like symptoms 2/11/2021.    Complaints:  Thirsty, sweaty  and seizure with no prior history.    Died at home.  Not sent to hospital.    Pronounced by coroner"
	"1093857-1"	"1093857-1"	"SEIZURE"	"10039906"	"65-79 years"	"65-79"	"According to the patient's wife, the patient had flu like symptoms 2/11/2021.    Complaints:  Thirsty, sweaty  and seizure with no prior history.    Died at home.  Not sent to hospital.    Pronounced by coroner"
	"1093857-1"	"1093857-1"	"THIRST"	"10043458"	"65-79 years"	"65-79"	"According to the patient's wife, the patient had flu like symptoms 2/11/2021.    Complaints:  Thirsty, sweaty  and seizure with no prior history.    Died at home.  Not sent to hospital.    Pronounced by coroner"
	"1094719-1"	"1094719-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient reported as deceased 3 days after vaccination by son."
	"1095170-1"	"1095170-1"	"ACUTE MYOCARDIAL INFARCTION"	"10000891"	"65-79 years"	"65-79"	"patient status started to decline within a few hours of receiving her covid vaccine she was weak, developed increased shortness of breath and went to the emergency room were she was diagnosed with STEMI and within 2 days expired."
	"1095170-1"	"1095170-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"patient status started to decline within a few hours of receiving her covid vaccine she was weak, developed increased shortness of breath and went to the emergency room were she was diagnosed with STEMI and within 2 days expired."
	"1095170-1"	"1095170-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"patient status started to decline within a few hours of receiving her covid vaccine she was weak, developed increased shortness of breath and went to the emergency room were she was diagnosed with STEMI and within 2 days expired."
	"1095170-1"	"1095170-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"patient status started to decline within a few hours of receiving her covid vaccine she was weak, developed increased shortness of breath and went to the emergency room were she was diagnosed with STEMI and within 2 days expired."
	"1095170-1"	"1095170-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"patient status started to decline within a few hours of receiving her covid vaccine she was weak, developed increased shortness of breath and went to the emergency room were she was diagnosed with STEMI and within 2 days expired."
	"1096952-1"	"1096952-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patients cancer progressed quicker than expected. Resulting in his passing"
	"1100865-1"	"1100865-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient died within 24 hours of vaccine.  Unknown at this time if related."
	"1101662-1"	"1101662-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"PATIENT PASSED AWAY BEFORE THEY COULD RECEIVE THE SECOND DOSE OF THE SHOT.  WE ARE NOT SURE IF IT WAS VACCINE RELATED OR NOT."
	"1101662-1"	"1101662-1"	"INCOMPLETE COURSE OF VACCINATION"	"10072103"	"65-79 years"	"65-79"	"PATIENT PASSED AWAY BEFORE THEY COULD RECEIVE THE SECOND DOSE OF THE SHOT.  WE ARE NOT SURE IF IT WAS VACCINE RELATED OR NOT."
	"1101690-1"	"1101690-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"THE PATIENT HAD PASSED AWAY AND WAS UNABLE TO GET HIS SECOND SHOT TO COMPLETE THE SERIES. WE ARE UNSURE IF THE VACCINE WAS RELATED TO HIM PASSING."
	"1101690-1"	"1101690-1"	"INCOMPLETE COURSE OF VACCINATION"	"10072103"	"65-79 years"	"65-79"	"THE PATIENT HAD PASSED AWAY AND WAS UNABLE TO GET HIS SECOND SHOT TO COMPLETE THE SERIES. WE ARE UNSURE IF THE VACCINE WAS RELATED TO HIM PASSING."
	"1101959-1"	"1101959-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"He passed on 02/06/2021"
	"1103186-1"	"1103186-1"	"ACUTE MYELOID LEUKAEMIA"	"10000880"	"65-79 years"	"65-79"	"Patient was vaccinated with the Pfizer vaccine in early February.  On February 19th, she was diagnosed with Acute Myeloid Leukemia"
	"1103186-1"	"1103186-1"	"BIOPSY BONE MARROW"	"10004737"	"65-79 years"	"65-79"	"Patient was vaccinated with the Pfizer vaccine in early February.  On February 19th, she was diagnosed with Acute Myeloid Leukemia"
	"1103186-1"	"1103186-1"	"FULL BLOOD COUNT"	"10017411"	"65-79 years"	"65-79"	"Patient was vaccinated with the Pfizer vaccine in early February.  On February 19th, she was diagnosed with Acute Myeloid Leukemia"
	"1106834-1"	"1106834-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient apparently expired 3/09/2021, no other information known, unknown if linked."
	"1107656-1"	"1107656-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient was found dead on 3/15/2021"
	"1108312-1"	"1108312-1"	"CAPILLARY LEAK SYNDROME"	"10007196"	"65-79 years"	"65-79"	"Severe exacerbation of idiopathic capillary leak syndrome 48 hours following administeration of Janssen vaccine leading to profound vasodilatory shock, renal failure and DIC and death"
	"1108312-1"	"1108312-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Severe exacerbation of idiopathic capillary leak syndrome 48 hours following administeration of Janssen vaccine leading to profound vasodilatory shock, renal failure and DIC and death"
	"1108312-1"	"1108312-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Severe exacerbation of idiopathic capillary leak syndrome 48 hours following administeration of Janssen vaccine leading to profound vasodilatory shock, renal failure and DIC and death"
	"1108312-1"	"1108312-1"	"DISSEMINATED INTRAVASCULAR COAGULATION"	"10013442"	"65-79 years"	"65-79"	"Severe exacerbation of idiopathic capillary leak syndrome 48 hours following administeration of Janssen vaccine leading to profound vasodilatory shock, renal failure and DIC and death"
	"1108312-1"	"1108312-1"	"DISTRIBUTIVE SHOCK"	"10070559"	"65-79 years"	"65-79"	"Severe exacerbation of idiopathic capillary leak syndrome 48 hours following administeration of Janssen vaccine leading to profound vasodilatory shock, renal failure and DIC and death"
	"1108312-1"	"1108312-1"	"RENAL FAILURE"	"10038435"	"65-79 years"	"65-79"	"Severe exacerbation of idiopathic capillary leak syndrome 48 hours following administeration of Janssen vaccine leading to profound vasodilatory shock, renal failure and DIC and death"
	"1108762-1"	"1108762-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Patient without previous cardiovascular history with complaints of chest tightness and diaphoresis. Contacted the doctor's office and sent advise to go to ER for possible cardiovascular event.  Witnessed cardiac arrest at home with unsuccessful resuscitation."
	"1108762-1"	"1108762-1"	"CHEST DISCOMFORT"	"10008469"	"65-79 years"	"65-79"	"Patient without previous cardiovascular history with complaints of chest tightness and diaphoresis. Contacted the doctor's office and sent advise to go to ER for possible cardiovascular event.  Witnessed cardiac arrest at home with unsuccessful resuscitation."
	"1108762-1"	"1108762-1"	"HYPERHIDROSIS"	"10020642"	"65-79 years"	"65-79"	"Patient without previous cardiovascular history with complaints of chest tightness and diaphoresis. Contacted the doctor's office and sent advise to go to ER for possible cardiovascular event.  Witnessed cardiac arrest at home with unsuccessful resuscitation."
	"1108762-1"	"1108762-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Patient without previous cardiovascular history with complaints of chest tightness and diaphoresis. Contacted the doctor's office and sent advise to go to ER for possible cardiovascular event.  Witnessed cardiac arrest at home with unsuccessful resuscitation."
	"1109350-1"	"1109350-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"unexplained death on 3/15/21"
	"1110537-1"	"1110537-1"	"BRAIN HERNIATION"	"10006126"	"65-79 years"	"65-79"	"Pt was found to be having stroke like symptoms 3/15 in the morning at nursing home.  he was evaluated and was transported by ambulance from one hospital to another hospital as the CT scanner was down.  patient had an injury on march 1 with a cabinet falling on him breaking his femur and family not sure if at that time he had hit his head.  Patient was intubated in the ER CT scan showed a massive cerebral bleed with midline shift and transtentorial herniation"
	"1110537-1"	"1110537-1"	"CEREBRAL HAEMORRHAGE"	"10008111"	"65-79 years"	"65-79"	"Pt was found to be having stroke like symptoms 3/15 in the morning at nursing home.  he was evaluated and was transported by ambulance from one hospital to another hospital as the CT scanner was down.  patient had an injury on march 1 with a cabinet falling on him breaking his femur and family not sure if at that time he had hit his head.  Patient was intubated in the ER CT scan showed a massive cerebral bleed with midline shift and transtentorial herniation"
	"1110537-1"	"1110537-1"	"CEREBRAL MASS EFFECT"	"10067086"	"65-79 years"	"65-79"	"Pt was found to be having stroke like symptoms 3/15 in the morning at nursing home.  he was evaluated and was transported by ambulance from one hospital to another hospital as the CT scanner was down.  patient had an injury on march 1 with a cabinet falling on him breaking his femur and family not sure if at that time he had hit his head.  Patient was intubated in the ER CT scan showed a massive cerebral bleed with midline shift and transtentorial herniation"
	"1110537-1"	"1110537-1"	"COMPUTERISED TOMOGRAM HEAD ABNORMAL"	"10072168"	"65-79 years"	"65-79"	"Pt was found to be having stroke like symptoms 3/15 in the morning at nursing home.  he was evaluated and was transported by ambulance from one hospital to another hospital as the CT scanner was down.  patient had an injury on march 1 with a cabinet falling on him breaking his femur and family not sure if at that time he had hit his head.  Patient was intubated in the ER CT scan showed a massive cerebral bleed with midline shift and transtentorial herniation"
	"1110537-1"	"1110537-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Pt was found to be having stroke like symptoms 3/15 in the morning at nursing home.  he was evaluated and was transported by ambulance from one hospital to another hospital as the CT scanner was down.  patient had an injury on march 1 with a cabinet falling on him breaking his femur and family not sure if at that time he had hit his head.  Patient was intubated in the ER CT scan showed a massive cerebral bleed with midline shift and transtentorial herniation"
	"1110537-1"	"1110537-1"	"NEUROLOGICAL SYMPTOM"	"10060860"	"65-79 years"	"65-79"	"Pt was found to be having stroke like symptoms 3/15 in the morning at nursing home.  he was evaluated and was transported by ambulance from one hospital to another hospital as the CT scanner was down.  patient had an injury on march 1 with a cabinet falling on him breaking his femur and family not sure if at that time he had hit his head.  Patient was intubated in the ER CT scan showed a massive cerebral bleed with midline shift and transtentorial herniation"
	"1110696-1"	"1110696-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away within 60 days of receiving a COVID vaccine"
	"1111039-1"	"1111039-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"patient passed away within 60 days of receiving a COVID vaccine"
	"1111699-1"	"1111699-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"Patient developed symptomatic COVID infection with symptoms starting 3/13, was admitted to the hospital for respiratory failure on 3/16 and expired on 3/18/21"
	"1111699-1"	"1111699-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient developed symptomatic COVID infection with symptoms starting 3/13, was admitted to the hospital for respiratory failure on 3/16 and expired on 3/18/21"
	"1111699-1"	"1111699-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Patient developed symptomatic COVID infection with symptoms starting 3/13, was admitted to the hospital for respiratory failure on 3/16 and expired on 3/18/21"
	"1111699-1"	"1111699-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient developed symptomatic COVID infection with symptoms starting 3/13, was admitted to the hospital for respiratory failure on 3/16 and expired on 3/18/21"
	"1111699-1"	"1111699-1"	"RENAL FAILURE"	"10038435"	"65-79 years"	"65-79"	"Patient developed symptomatic COVID infection with symptoms starting 3/13, was admitted to the hospital for respiratory failure on 3/16 and expired on 3/18/21"
	"1111699-1"	"1111699-1"	"RESPIRATORY FAILURE"	"10038695"	"65-79 years"	"65-79"	"Patient developed symptomatic COVID infection with symptoms starting 3/13, was admitted to the hospital for respiratory failure on 3/16 and expired on 3/18/21"
	"1111699-1"	"1111699-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient developed symptomatic COVID infection with symptoms starting 3/13, was admitted to the hospital for respiratory failure on 3/16 and expired on 3/18/21"
	"1111924-1"	"1111924-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient found demised at home on 3/17/2021"
	"1115581-1"	"1115581-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Unattended Death, symptoms and timeframe unknown, death occurred approximately 1 week post vaccination"
	"1116353-1"	"1116353-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away within 60 days of receiving the COVID vaccine series"
	"1123247-1"	"1123247-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Our agency was alerted that the patient passed away on 3/16/2021"
	"1124577-1"	"1124577-1"	"ALANINE AMINOTRANSFERASE INCREASED"	"10001551"	"65-79 years"	"65-79"	"My father received the first Covid shot 3/2; he woke up 3/3 with severe body aches and weakness, which we thought nothing of.  However, every day, he got weaker and weaker. He has been treated for Liver cancer, he received his first infusion of Opdivo almost 4 weeks before the vaccination.  About 7 days after the shot, he was having trouble swallowing so he went to the ER to get a CT scan. He was found to have greatly elevated troponins, the DR was baffled he wasn?t having any chest pain; they were apparently not trending either., he has never had a heart attack or any other heart problems, takes Nadolol for high blood pressure. The CT scan showed significant growth of his tumors  which had been stable for a year and the last CT scan was the end of January; liver enzymes were also significantly elevated whereas they were stable before.  My father deteriorated rapidly, and died on 3/18/21. The day he got the shot just prior, he was hauling wood, shoveling snow and living a normal life feeling good. The day after the shot he could barely get out of bed he was so weak, until he finally died 16 days later."
	"1124577-1"	"1124577-1"	"ASPARTATE AMINOTRANSFERASE INCREASED"	"10003481"	"65-79 years"	"65-79"	"My father received the first Covid shot 3/2; he woke up 3/3 with severe body aches and weakness, which we thought nothing of.  However, every day, he got weaker and weaker. He has been treated for Liver cancer, he received his first infusion of Opdivo almost 4 weeks before the vaccination.  About 7 days after the shot, he was having trouble swallowing so he went to the ER to get a CT scan. He was found to have greatly elevated troponins, the DR was baffled he wasn?t having any chest pain; they were apparently not trending either., he has never had a heart attack or any other heart problems, takes Nadolol for high blood pressure. The CT scan showed significant growth of his tumors  which had been stable for a year and the last CT scan was the end of January; liver enzymes were also significantly elevated whereas they were stable before.  My father deteriorated rapidly, and died on 3/18/21. The day he got the shot just prior, he was hauling wood, shoveling snow and living a normal life feeling good. The day after the shot he could barely get out of bed he was so weak, until he finally died 16 days later."
	"1124577-1"	"1124577-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"My father received the first Covid shot 3/2; he woke up 3/3 with severe body aches and weakness, which we thought nothing of.  However, every day, he got weaker and weaker. He has been treated for Liver cancer, he received his first infusion of Opdivo almost 4 weeks before the vaccination.  About 7 days after the shot, he was having trouble swallowing so he went to the ER to get a CT scan. He was found to have greatly elevated troponins, the DR was baffled he wasn?t having any chest pain; they were apparently not trending either., he has never had a heart attack or any other heart problems, takes Nadolol for high blood pressure. The CT scan showed significant growth of his tumors  which had been stable for a year and the last CT scan was the end of January; liver enzymes were also significantly elevated whereas they were stable before.  My father deteriorated rapidly, and died on 3/18/21. The day he got the shot just prior, he was hauling wood, shoveling snow and living a normal life feeling good. The day after the shot he could barely get out of bed he was so weak, until he finally died 16 days later."
	"1124577-1"	"1124577-1"	"COMPUTERISED TOMOGRAM ABNORMAL"	"10010235"	"65-79 years"	"65-79"	"My father received the first Covid shot 3/2; he woke up 3/3 with severe body aches and weakness, which we thought nothing of.  However, every day, he got weaker and weaker. He has been treated for Liver cancer, he received his first infusion of Opdivo almost 4 weeks before the vaccination.  About 7 days after the shot, he was having trouble swallowing so he went to the ER to get a CT scan. He was found to have greatly elevated troponins, the DR was baffled he wasn?t having any chest pain; they were apparently not trending either., he has never had a heart attack or any other heart problems, takes Nadolol for high blood pressure. The CT scan showed significant growth of his tumors  which had been stable for a year and the last CT scan was the end of January; liver enzymes were also significantly elevated whereas they were stable before.  My father deteriorated rapidly, and died on 3/18/21. The day he got the shot just prior, he was hauling wood, shoveling snow and living a normal life feeling good. The day after the shot he could barely get out of bed he was so weak, until he finally died 16 days later."
	"1124577-1"	"1124577-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"My father received the first Covid shot 3/2; he woke up 3/3 with severe body aches and weakness, which we thought nothing of.  However, every day, he got weaker and weaker. He has been treated for Liver cancer, he received his first infusion of Opdivo almost 4 weeks before the vaccination.  About 7 days after the shot, he was having trouble swallowing so he went to the ER to get a CT scan. He was found to have greatly elevated troponins, the DR was baffled he wasn?t having any chest pain; they were apparently not trending either., he has never had a heart attack or any other heart problems, takes Nadolol for high blood pressure. The CT scan showed significant growth of his tumors  which had been stable for a year and the last CT scan was the end of January; liver enzymes were also significantly elevated whereas they were stable before.  My father deteriorated rapidly, and died on 3/18/21. The day he got the shot just prior, he was hauling wood, shoveling snow and living a normal life feeling good. The day after the shot he could barely get out of bed he was so weak, until he finally died 16 days later."
	"1124577-1"	"1124577-1"	"DYSPHAGIA"	"10013950"	"65-79 years"	"65-79"	"My father received the first Covid shot 3/2; he woke up 3/3 with severe body aches and weakness, which we thought nothing of.  However, every day, he got weaker and weaker. He has been treated for Liver cancer, he received his first infusion of Opdivo almost 4 weeks before the vaccination.  About 7 days after the shot, he was having trouble swallowing so he went to the ER to get a CT scan. He was found to have greatly elevated troponins, the DR was baffled he wasn?t having any chest pain; they were apparently not trending either., he has never had a heart attack or any other heart problems, takes Nadolol for high blood pressure. The CT scan showed significant growth of his tumors  which had been stable for a year and the last CT scan was the end of January; liver enzymes were also significantly elevated whereas they were stable before.  My father deteriorated rapidly, and died on 3/18/21. The day he got the shot just prior, he was hauling wood, shoveling snow and living a normal life feeling good. The day after the shot he could barely get out of bed he was so weak, until he finally died 16 days later."
	"1124577-1"	"1124577-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"My father received the first Covid shot 3/2; he woke up 3/3 with severe body aches and weakness, which we thought nothing of.  However, every day, he got weaker and weaker. He has been treated for Liver cancer, he received his first infusion of Opdivo almost 4 weeks before the vaccination.  About 7 days after the shot, he was having trouble swallowing so he went to the ER to get a CT scan. He was found to have greatly elevated troponins, the DR was baffled he wasn?t having any chest pain; they were apparently not trending either., he has never had a heart attack or any other heart problems, takes Nadolol for high blood pressure. The CT scan showed significant growth of his tumors  which had been stable for a year and the last CT scan was the end of January; liver enzymes were also significantly elevated whereas they were stable before.  My father deteriorated rapidly, and died on 3/18/21. The day he got the shot just prior, he was hauling wood, shoveling snow and living a normal life feeling good. The day after the shot he could barely get out of bed he was so weak, until he finally died 16 days later."
	"1124577-1"	"1124577-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	"My father received the first Covid shot 3/2; he woke up 3/3 with severe body aches and weakness, which we thought nothing of.  However, every day, he got weaker and weaker. He has been treated for Liver cancer, he received his first infusion of Opdivo almost 4 weeks before the vaccination.  About 7 days after the shot, he was having trouble swallowing so he went to the ER to get a CT scan. He was found to have greatly elevated troponins, the DR was baffled he wasn?t having any chest pain; they were apparently not trending either., he has never had a heart attack or any other heart problems, takes Nadolol for high blood pressure. The CT scan showed significant growth of his tumors  which had been stable for a year and the last CT scan was the end of January; liver enzymes were also significantly elevated whereas they were stable before.  My father deteriorated rapidly, and died on 3/18/21. The day he got the shot just prior, he was hauling wood, shoveling snow and living a normal life feeling good. The day after the shot he could barely get out of bed he was so weak, until he finally died 16 days later."
	"1124577-1"	"1124577-1"	"TROPONIN INCREASED"	"10058267"	"65-79 years"	"65-79"	"My father received the first Covid shot 3/2; he woke up 3/3 with severe body aches and weakness, which we thought nothing of.  However, every day, he got weaker and weaker. He has been treated for Liver cancer, he received his first infusion of Opdivo almost 4 weeks before the vaccination.  About 7 days after the shot, he was having trouble swallowing so he went to the ER to get a CT scan. He was found to have greatly elevated troponins, the DR was baffled he wasn?t having any chest pain; they were apparently not trending either., he has never had a heart attack or any other heart problems, takes Nadolol for high blood pressure. The CT scan showed significant growth of his tumors  which had been stable for a year and the last CT scan was the end of January; liver enzymes were also significantly elevated whereas they were stable before.  My father deteriorated rapidly, and died on 3/18/21. The day he got the shot just prior, he was hauling wood, shoveling snow and living a normal life feeling good. The day after the shot he could barely get out of bed he was so weak, until he finally died 16 days later."
	"1126135-1"	"1126135-1"	"CARDIAC DISORDER"	"10061024"	"65-79 years"	"65-79"	""I am writing this on behalf of my mother. She received the first round of the vaccine (Pfizer/EL9269) on 2/18/21. That evening she reported not feeling ""right"".  Over the next two days after receiving the vaccine on Thursday she reported to family that she didnt feel well. She had no fever but muscle aches, an earache and sore throat (this was on Friday and Saturday). On Sunday her breathing became a bit labored. She still had previous symptoms reported and labored breathing -- she stated she thought she would have to go to the Dr the next day (Monday, Feb 22, 201) if she did not feel better.   Sometime in the night of Feb 21st and Feb 22nd my mom passed away.   My mom had many health problems. Heart disease, diabetic, she was on dialysis and had sleep apnea. However, she definitely seemed to be having some difficulty with the affects of the first vaccine.   Please let her life be counted.""
	"1126135-1"	"1126135-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	""I am writing this on behalf of my mother. She received the first round of the vaccine (Pfizer/EL9269) on 2/18/21. That evening she reported not feeling ""right"".  Over the next two days after receiving the vaccine on Thursday she reported to family that she didnt feel well. She had no fever but muscle aches, an earache and sore throat (this was on Friday and Saturday). On Sunday her breathing became a bit labored. She still had previous symptoms reported and labored breathing -- she stated she thought she would have to go to the Dr the next day (Monday, Feb 22, 201) if she did not feel better.   Sometime in the night of Feb 21st and Feb 22nd my mom passed away.   My mom had many health problems. Heart disease, diabetic, she was on dialysis and had sleep apnea. However, she definitely seemed to be having some difficulty with the affects of the first vaccine.   Please let her life be counted.""
	"1126135-1"	"1126135-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	""I am writing this on behalf of my mother. She received the first round of the vaccine (Pfizer/EL9269) on 2/18/21. That evening she reported not feeling ""right"".  Over the next two days after receiving the vaccine on Thursday she reported to family that she didnt feel well. She had no fever but muscle aches, an earache and sore throat (this was on Friday and Saturday). On Sunday her breathing became a bit labored. She still had previous symptoms reported and labored breathing -- she stated she thought she would have to go to the Dr the next day (Monday, Feb 22, 201) if she did not feel better.   Sometime in the night of Feb 21st and Feb 22nd my mom passed away.   My mom had many health problems. Heart disease, diabetic, she was on dialysis and had sleep apnea. However, she definitely seemed to be having some difficulty with the affects of the first vaccine.   Please let her life be counted.""
	"1126135-1"	"1126135-1"	"EAR PAIN"	"10014020"	"65-79 years"	"65-79"	""I am writing this on behalf of my mother. She received the first round of the vaccine (Pfizer/EL9269) on 2/18/21. That evening she reported not feeling ""right"".  Over the next two days after receiving the vaccine on Thursday she reported to family that she didnt feel well. She had no fever but muscle aches, an earache and sore throat (this was on Friday and Saturday). On Sunday her breathing became a bit labored. She still had previous symptoms reported and labored breathing -- she stated she thought she would have to go to the Dr the next day (Monday, Feb 22, 201) if she did not feel better.   Sometime in the night of Feb 21st and Feb 22nd my mom passed away.   My mom had many health problems. Heart disease, diabetic, she was on dialysis and had sleep apnea. However, she definitely seemed to be having some difficulty with the affects of the first vaccine.   Please let her life be counted.""
	"1126135-1"	"1126135-1"	"FEELING ABNORMAL"	"10016322"	"65-79 years"	"65-79"	""I am writing this on behalf of my mother. She received the first round of the vaccine (Pfizer/EL9269) on 2/18/21. That evening she reported not feeling ""right"".  Over the next two days after receiving the vaccine on Thursday she reported to family that she didnt feel well. She had no fever but muscle aches, an earache and sore throat (this was on Friday and Saturday). On Sunday her breathing became a bit labored. She still had previous symptoms reported and labored breathing -- she stated she thought she would have to go to the Dr the next day (Monday, Feb 22, 201) if she did not feel better.   Sometime in the night of Feb 21st and Feb 22nd my mom passed away.   My mom had many health problems. Heart disease, diabetic, she was on dialysis and had sleep apnea. However, she definitely seemed to be having some difficulty with the affects of the first vaccine.   Please let her life be counted.""
	"1126135-1"	"1126135-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	""I am writing this on behalf of my mother. She received the first round of the vaccine (Pfizer/EL9269) on 2/18/21. That evening she reported not feeling ""right"".  Over the next two days after receiving the vaccine on Thursday she reported to family that she didnt feel well. She had no fever but muscle aches, an earache and sore throat (this was on Friday and Saturday). On Sunday her breathing became a bit labored. She still had previous symptoms reported and labored breathing -- she stated she thought she would have to go to the Dr the next day (Monday, Feb 22, 201) if she did not feel better.   Sometime in the night of Feb 21st and Feb 22nd my mom passed away.   My mom had many health problems. Heart disease, diabetic, she was on dialysis and had sleep apnea. However, she definitely seemed to be having some difficulty with the affects of the first vaccine.   Please let her life be counted.""
	"1126135-1"	"1126135-1"	"MYALGIA"	"10028411"	"65-79 years"	"65-79"	""I am writing this on behalf of my mother. She received the first round of the vaccine (Pfizer/EL9269) on 2/18/21. That evening she reported not feeling ""right"".  Over the next two days after receiving the vaccine on Thursday she reported to family that she didnt feel well. She had no fever but muscle aches, an earache and sore throat (this was on Friday and Saturday). On Sunday her breathing became a bit labored. She still had previous symptoms reported and labored breathing -- she stated she thought she would have to go to the Dr the next day (Monday, Feb 22, 201) if she did not feel better.   Sometime in the night of Feb 21st and Feb 22nd my mom passed away.   My mom had many health problems. Heart disease, diabetic, she was on dialysis and had sleep apnea. However, she definitely seemed to be having some difficulty with the affects of the first vaccine.   Please let her life be counted.""
	"1126135-1"	"1126135-1"	"OROPHARYNGEAL PAIN"	"10068319"	"65-79 years"	"65-79"	""I am writing this on behalf of my mother. She received the first round of the vaccine (Pfizer/EL9269) on 2/18/21. That evening she reported not feeling ""right"".  Over the next two days after receiving the vaccine on Thursday she reported to family that she didnt feel well. She had no fever but muscle aches, an earache and sore throat (this was on Friday and Saturday). On Sunday her breathing became a bit labored. She still had previous symptoms reported and labored breathing -- she stated she thought she would have to go to the Dr the next day (Monday, Feb 22, 201) if she did not feel better.   Sometime in the night of Feb 21st and Feb 22nd my mom passed away.   My mom had many health problems. Heart disease, diabetic, she was on dialysis and had sleep apnea. However, she definitely seemed to be having some difficulty with the affects of the first vaccine.   Please let her life be counted.""
	"1126293-1"	"1126293-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death 10 days after receiving first moderna covid vaccination. Was not told by patients family cause of death, unclear if there is a link between vaccination or not."
	"1129706-1"	"1129706-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient presented to SJMC in Brainerd by private car, 3/23/21 DOA.  Family with patient wanted no resuscitation.  Patient pronounced deceased 2:49 pm."
	"1129951-1"	"1129951-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"72 y/o with hx of HTN, Aortic valve replacement, venous stasis and venous insufficiency of both lower extremities, CAD, AAA, and s/p squamous cell carcinoma excision in 2019  Upon reviewing the history, here is what we found.   1. 2/27 -- Received send-out covid swabbing/testing- Patient did not disclose this information when screened for his covid vaccination at the clinic.   2. 3/2, 10:00 AM ? Presented to Covid Vaccination Clinic and received 1st dose of Moderna. Results of pending covid test were not back at this time, nor did he disclose this information when screened by nurse prior to vaccination.  3. 3/2, 10:30 PM ? Covid result came back to lab as positive SARS Co-V 2019  4. 3/3 ? patient called and notified of result per ED nurse   5. 3/3 ? Pharmacy recommended patient for mAB infusion (patient did not receive it)   6. 3/6 ? patient presents to ED in severe respiratory distress, DX of Covid-19 pneumonia & transferred to ICU  7. 3/21 ? patient dies after 15 day hospitalization in ICU (pt. had received convalescent plasma x 2 and remdesivir there)"
	"1129951-1"	"1129951-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"72 y/o with hx of HTN, Aortic valve replacement, venous stasis and venous insufficiency of both lower extremities, CAD, AAA, and s/p squamous cell carcinoma excision in 2019  Upon reviewing the history, here is what we found.   1. 2/27 -- Received send-out covid swabbing/testing- Patient did not disclose this information when screened for his covid vaccination at the clinic.   2. 3/2, 10:00 AM ? Presented to Covid Vaccination Clinic and received 1st dose of Moderna. Results of pending covid test were not back at this time, nor did he disclose this information when screened by nurse prior to vaccination.  3. 3/2, 10:30 PM ? Covid result came back to lab as positive SARS Co-V 2019  4. 3/3 ? patient called and notified of result per ED nurse   5. 3/3 ? Pharmacy recommended patient for mAB infusion (patient did not receive it)   6. 3/6 ? patient presents to ED in severe respiratory distress, DX of Covid-19 pneumonia & transferred to ICU  7. 3/21 ? patient dies after 15 day hospitalization in ICU (pt. had received convalescent plasma x 2 and remdesivir there)"
	"1129951-1"	"1129951-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"72 y/o with hx of HTN, Aortic valve replacement, venous stasis and venous insufficiency of both lower extremities, CAD, AAA, and s/p squamous cell carcinoma excision in 2019  Upon reviewing the history, here is what we found.   1. 2/27 -- Received send-out covid swabbing/testing- Patient did not disclose this information when screened for his covid vaccination at the clinic.   2. 3/2, 10:00 AM ? Presented to Covid Vaccination Clinic and received 1st dose of Moderna. Results of pending covid test were not back at this time, nor did he disclose this information when screened by nurse prior to vaccination.  3. 3/2, 10:30 PM ? Covid result came back to lab as positive SARS Co-V 2019  4. 3/3 ? patient called and notified of result per ED nurse   5. 3/3 ? Pharmacy recommended patient for mAB infusion (patient did not receive it)   6. 3/6 ? patient presents to ED in severe respiratory distress, DX of Covid-19 pneumonia & transferred to ICU  7. 3/21 ? patient dies after 15 day hospitalization in ICU (pt. had received convalescent plasma x 2 and remdesivir there)"
	"1129951-1"	"1129951-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"72 y/o with hx of HTN, Aortic valve replacement, venous stasis and venous insufficiency of both lower extremities, CAD, AAA, and s/p squamous cell carcinoma excision in 2019  Upon reviewing the history, here is what we found.   1. 2/27 -- Received send-out covid swabbing/testing- Patient did not disclose this information when screened for his covid vaccination at the clinic.   2. 3/2, 10:00 AM ? Presented to Covid Vaccination Clinic and received 1st dose of Moderna. Results of pending covid test were not back at this time, nor did he disclose this information when screened by nurse prior to vaccination.  3. 3/2, 10:30 PM ? Covid result came back to lab as positive SARS Co-V 2019  4. 3/3 ? patient called and notified of result per ED nurse   5. 3/3 ? Pharmacy recommended patient for mAB infusion (patient did not receive it)   6. 3/6 ? patient presents to ED in severe respiratory distress, DX of Covid-19 pneumonia & transferred to ICU  7. 3/21 ? patient dies after 15 day hospitalization in ICU (pt. had received convalescent plasma x 2 and remdesivir there)"
	"1129951-1"	"1129951-1"	"RESPIRATORY DISTRESS"	"10038687"	"65-79 years"	"65-79"	"72 y/o with hx of HTN, Aortic valve replacement, venous stasis and venous insufficiency of both lower extremities, CAD, AAA, and s/p squamous cell carcinoma excision in 2019  Upon reviewing the history, here is what we found.   1. 2/27 -- Received send-out covid swabbing/testing- Patient did not disclose this information when screened for his covid vaccination at the clinic.   2. 3/2, 10:00 AM ? Presented to Covid Vaccination Clinic and received 1st dose of Moderna. Results of pending covid test were not back at this time, nor did he disclose this information when screened by nurse prior to vaccination.  3. 3/2, 10:30 PM ? Covid result came back to lab as positive SARS Co-V 2019  4. 3/3 ? patient called and notified of result per ED nurse   5. 3/3 ? Pharmacy recommended patient for mAB infusion (patient did not receive it)   6. 3/6 ? patient presents to ED in severe respiratory distress, DX of Covid-19 pneumonia & transferred to ICU  7. 3/21 ? patient dies after 15 day hospitalization in ICU (pt. had received convalescent plasma x 2 and remdesivir there)"
	"1129951-1"	"1129951-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"72 y/o with hx of HTN, Aortic valve replacement, venous stasis and venous insufficiency of both lower extremities, CAD, AAA, and s/p squamous cell carcinoma excision in 2019  Upon reviewing the history, here is what we found.   1. 2/27 -- Received send-out covid swabbing/testing- Patient did not disclose this information when screened for his covid vaccination at the clinic.   2. 3/2, 10:00 AM ? Presented to Covid Vaccination Clinic and received 1st dose of Moderna. Results of pending covid test were not back at this time, nor did he disclose this information when screened by nurse prior to vaccination.  3. 3/2, 10:30 PM ? Covid result came back to lab as positive SARS Co-V 2019  4. 3/3 ? patient called and notified of result per ED nurse   5. 3/3 ? Pharmacy recommended patient for mAB infusion (patient did not receive it)   6. 3/6 ? patient presents to ED in severe respiratory distress, DX of Covid-19 pneumonia & transferred to ICU  7. 3/21 ? patient dies after 15 day hospitalization in ICU (pt. had received convalescent plasma x 2 and remdesivir there)"
	"1130777-1"	"1130777-1"	"ATRIAL FIBRILLATION"	"10003658"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"AUTOPSY"	"10050117"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"DIZZINESS"	"10013573"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"DYSPEPSIA"	"10013946"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"FEELING ABNORMAL"	"10016322"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"LACTIC ACIDOSIS"	"10023676"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"LUNG INFILTRATION"	"10025102"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"MENTAL STATUS CHANGES"	"10048294"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"MULTIPLE ORGAN DYSFUNCTION SYNDROME"	"10077361"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"PLEURAL EFFUSION"	"10035598"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"PNEUMONIA"	"10035664"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"SHOCK"	"10040560"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1130777-1"	"1130777-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	""1st vaccine on 2/20 and reported feeling ""lousy"" afterwards. On the evening of 2/23 felt like she was going to pass out. Felt worse when she woke the next morning. Presented to the ER on 2/24 with chest pain and ""indigestion"". Found to be in A.Fib with RVR. Vomited in ER triage. On 2/25 developed altered mental status, hypotension, hypoxemia. She was intubated and transferred to the ICU with severe lactic acidosis/shock/multiorgan failure. Had Right lower lobe infiltrate and right pleural effusion. Diagnosed with pneumonia and possible ischemic bowel.  Died on 2/26. Family requested autopsy.""
	"1134021-1"	"1134021-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient death within 60 days of receiving the COVID vaccine series"
	"1134376-1"	"1134376-1"	"CARDIOGENIC SHOCK"	"10007625"	"65-79 years"	"65-79"	"Patient passed away from cardiogenic shock after a CABG"
	"1134376-1"	"1134376-1"	"CORONARY ARTERY BYPASS"	"10011077"	"65-79 years"	"65-79"	"Patient passed away from cardiogenic shock after a CABG"
	"1134376-1"	"1134376-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away from cardiogenic shock after a CABG"
	"1134398-1"	"1134398-1"	"ALANINE AMINOTRANSFERASE INCREASED"	"10001551"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"ANGIOCARDIOGRAM"	"10080743"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"ASPARTATE AMINOTRANSFERASE INCREASED"	"10003481"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"ATRIAL FIBRILLATION"	"10003658"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"BLADDER CATHETERISATION"	"10005028"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"BLOOD ALBUMIN NORMAL"	"10005289"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"BLOOD BICARBONATE"	"10005357"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"BLOOD CHLORIDE NORMAL"	"10005421"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"BLOOD CREATINE PHOSPHOKINASE INCREASED"	"10005470"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"BLOOD CREATININE NORMAL"	"10005484"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"BLOOD GLUCOSE INCREASED"	"10005557"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"BLOOD LACTIC ACID"	"10005632"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"BLOOD MAGNESIUM INCREASED"	"10005655"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"BLOOD PH DECREASED"	"10005706"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"BLOOD POTASSIUM DECREASED"	"10005724"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"BLOOD SODIUM NORMAL"	"10005804"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"BLOOD UREA NORMAL"	"10005857"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"BLOOD URINE PRESENT"	"10018870"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"BRAIN STEM ISCHAEMIA"	"10006148"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"BUNDLE BRANCH BLOCK RIGHT"	"10006582"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"CARDIAC VENTRICULOGRAM"	"10053445"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"CATHETERISATION CARDIAC"	"10007815"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"CATHETERISATION CARDIAC ABNORMAL"	"10007816"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"CEREBRAL ARTERY EMBOLISM"	"10008088"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"CYANOSIS"	"10011703"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"EJECTION FRACTION DECREASED"	"10050528"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"ELECTROCARDIOGRAM ABNORMAL"	"10014363"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"ELECTROENCEPHALOGRAM ABNORMAL"	"10014408"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"ENCEPHALOPATHY"	"10014625"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"GAIT DISTURBANCE"	"10017577"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"GLIOSIS"	"10018341"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"GLOMERULAR FILTRATION RATE DECREASED"	"10018358"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"HAEMATOCRIT NORMAL"	"10018842"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"HAEMOGLOBIN NORMAL"	"10018890"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"HYPOKALAEMIA"	"10021015"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"HYPOMAGNESAEMIA"	"10021027"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"INTERNATIONAL NORMALISED RATIO INCREASED"	"10022595"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"LEFT VENTRICULAR DYSFUNCTION"	"10049694"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"LIVER FUNCTION TEST INCREASED"	"10077692"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES"	"10079487"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"LUNG OPACITY"	"10081792"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"MAGNETIC RESONANCE IMAGING HEAD ABNORMAL"	"10085256"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"N-TERMINAL PROHORMONE BRAIN NATRIURETIC PEPTIDE INCREASED"	"10071662"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"PCO2 INCREASED"	"10034183"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"PLATELET COUNT DECREASED"	"10035528"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"PNEUMONITIS"	"10035742"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"PO2 DECREASED"	"10035768"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"PROCALCITONIN"	"10064051"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"PROCALCITONIN NORMAL"	"10077831"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"PULSELESS ELECTRICAL ACTIVITY"	"10058151"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"THERAPEUTIC HYPOTHERMIA"	"10059485"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"TROPONIN INCREASED"	"10058267"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1134398-1"	"1134398-1"	"WHITE BLOOD CELL COUNT NORMAL"	"10047944"	"65-79 years"	"65-79"	"She had been in her usual state of health until tonight. Assisted living facility staff called. He mentioned that the facility staff had earlier noticed that she was dragging her right foot and and has been needing more assistance with activities. The patient was walking and did not feel well. She was lowered to the ground and had a witnessed cardiac arrest. The ambulance was called and she was reportedly found to have pulseless electrical activity. She was given Epinephrine and Amiodarone with return of pulse. The patient was brought to the Emergency Room and was evaluated by ER physician. EKG showed atrial fibrillation, ventricular rate = 66, RBBB with Brugada pattern. She was emergently brought to the Cath Lab. Cardiac catheterization showed normal coronary arteries but EF 35-40%. Repeat EKG showed atrial fibrillation with rapid ventricular response = 110, RBBB. Therapeutic hypothermia was initiated. The patient was admitted to the ICU on mechanical ventilation with TV 350 RR 14 PEEP 5. She is sedated with Propofol and Fentanyl IV. She is on Levophed IV. ABG showed pH = 7.22, pCO2 = 53, pO2 = 66, O2 sat = 88%. Lactate level = 9.5. WBC 8.8, Hgb 13.4, Hct 46, Platelets 138. Na 138, K 3.2, Cl 102, bicarb 20, BUN 16, Crea 1.19, estimated GFR = 44 mL/minute. Magnesium 2.7. Glucose levels have ranged from 273-312. Pro-Calcitonin = 0.26. Albumin 3.7. SGOT 262, SGPT 294. Troponin elevated at 47. Pro-BNP = 600. Urinalysis showed large blood. Chest x-ray showed vague peripheral pneumonitis. Endotracheal tube is in place. COVID-19 test by PCR is negative (2/5/21).    COURSE IN HOSPITAL  The patient was admitted to the ICU and was followed by Pulmonary/Critical Care.  Patient was maintained on mechanical ventilation, sedated with propofol and fentanyl IV.  Vasopressors were administered (Levophed IV).  She was managed with therapeutic hypothermia.  She was followed by Cardiology.  Foley catheter was inserted for close input/output monitoring.  Neuro checks, vital signs, daily weights, pulse oximetry, cardiac telemetry and fingersticks were monitored.  She was given sodium bicarbonate IV due to metabolic acidosis.  She was also given insulin IV drip.  Potassium chloride IV was administered due to hypokalemia.  The patient was given amiodarone IV.  Platelet count was noted to be low but stable.  Glucose levels were within acceptable range.  Metabolic acidosis resolved.  Hypokalemia resolved.  Hypomagnesemia resolved.  There were elevated LFTs which improved.  Elevated CPK also improved.  She was taken off hypothermia protocol.  Sedation was decreased and she was able to open her eyes with verbal stimulus but unable to follow commands.  Ammonia level was normal.  Neurology evaluated the patient.  EEG showed left periodic epileptiform discharges consistent with severe diffuse encephalopathy.  Chest x-ray revealed right upper lung and left mid lung increasing opacity for which meropenem IV was started.  Levophed was discontinued.  Initially she had peripheral cyanosis, but this resolved upon discontinuation of vasopressors.  Brain MRI was done demonstrating diffuse bilateral small and moderate-sized ischemic foci throughout the cerebellum and cerebellar region suggestive of embolism.  There also was chronic marked atrophy and moderate small-vessel gliosis.  CIRCUMSTANCES SURROUNDING DEMISE  Based on neurologic evaluation, her prognosis for meaningful neurologic recovery was thought to be extremely poor.  The patient was evaluated and followed by Palliative Care. She does not have family members and had designated her neighbor friends as her power of attorney. They have known the patient for a ling time and they know that she does not want to live like this. A decision was therefore made for comfort care measures only. Compassionate extubation was performed on February 12, 2021. The patient passed away on February 12, 2021, at 6:39 p.m."
	"1140696-1"	"1140696-1"	"ACUTE MYELOID LEUKAEMIA"	"10000880"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"BAND NEUTROPHIL COUNT"	"10059477"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"BAND NEUTROPHIL COUNT INCREASED"	"10050759"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"BLAST CELL COUNT INCREASED"	"10062274"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"BLAST CELLS"	"10061700"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"CEREBRAL HAEMORRHAGE"	"10008111"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"DISSEMINATED INTRAVASCULAR COAGULATION"	"10013442"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"HAEMORRHAGIC STROKE"	"10019016"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"ISCHAEMIC STROKE"	"10061256"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"LEUKAEMIA"	"10024288"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"METAMYELOCYTE COUNT"	"10050965"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"METAMYELOCYTE COUNT INCREASED"	"10050765"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"MONOCYTE COUNT"	"10027876"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"MONOCYTE COUNT INCREASED"	"10027880"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"MYELOCYTE COUNT"	"10050966"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"MYELOCYTE COUNT INCREASED"	"10050985"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"NEUTROPHIL COUNT"	"10029363"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"NEUTROPHIL COUNT DECREASED"	"10029366"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"PAIN IN EXTREMITY"	"10033425"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"PLATELET COUNT"	"10035525"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"PLATELET COUNT DECREASED"	"10035528"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"RED CELL DISTRIBUTION WIDTH"	"10051168"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"RED CELL DISTRIBUTION WIDTH INCREASED"	"10053920"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"SARS-COV-2 TEST"	"10084354"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1140696-1"	"1140696-1"	"THROMBOSIS"	"10043607"	"65-79 years"	"65-79"	"Multifocal Intracerebral Hemorrhage; Disseminated Intravascular Coagulopathy; strokes, Ischemic and Hemorrhagic; strokes, Ischemic and Hemorrhagic; AML; Leukemia; Blood clot diagnosis; Sore lower leg; RDW Stand. Dev. H/RDW Coeff Var H; Platelet Count L, Platelet Vol L; Neutrophils L; Band Neutrophils H; Monocytes H; Metamyelocytes H; Myelocytes H; Absolute Neutrophils L; Other Cell Type Blast Like Cells H; This is a spontaneous report from a contactable consumer. A 70-year-old female patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) lot number: EL9261, via an unspecified route of administration, administered in Arm Right on 02Feb2021 08:30 (Batch/Lot Number: EL9261) as SINGLE DOSE for covid-19 immunisation. Medical history included breast cancer (8 years ago no chemo just radiation). Historical vaccine included first dose of BNT162B2 (lot number: EL0140) on 11Jan2021 for Covid-19 immunization. Concomitant medication included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]), calcium citrate, colecalciferol (CALCIUM CITRATE + D3), glucosamine, magnesium citrate, docosahexaenoic acid, eicosapentaenoic acid, tocopheryl acetate (OMEGA 3 [DOCOSAHEXAENOIC ACID;EICOSAPENTAENOIC ACID;TOCOPHERYL ACETATE]) and curcuma longa (TURMERIC [CURCUMA LONGA]). On 04Feb2021, the patient's blood work result showed red cell distribution width (RDW) stand. dev. high; RDW coeff var high, platelet count low, platelet vol low; neutrophils low; band neutrophils high; monocytes high; metamyelocytes high; myelocytes high; absolute neutrophils low; other cell type blast like cells high. On 15Feb2021, the patient experienced sore lower leg. On 16Feb2021, the patient was diagnosed with blood clot. On 19Feb2021, the patient was diagnosed with leukemia. On 20Feb2021, the patient was diagnosed with acute myeloid leukemia (AML). On 21Feb2021, the patient had tow types of stroke, ischemic and hemorrhagic, the patient was intubated. On 23Feb2021, the patient was extubated and died due to multifocal intracerebral hemorrhage, disseminated intravascular coagulopathy, acute myeloid leukemia with blast crisis. The patient received chemotherapy and leukapheresis as treatment. The patient died on 23Feb2021.  An autopsy was not performed.; Reported Cause(s) of Death: Disseminated Intravascular Coagulopathy; Acute Myeloid Leukemia With Blast Crisis; Multifocal Intracerebral Hemorrhage"
	"1147303-1"	"1147303-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient death within 60 days of receiving a COVID vaccine"
	"1147428-1"	"1147428-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient hospitalization and death within 60 days of receiving a COVID vaccine"
	"1147518-1"	"1147518-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient death within 60 days of receiving a COVID vaccine"
	"1147625-1"	"1147625-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient death within 60 days of receiving a COVID vaccine"
	"1149492-1"	"1149492-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient death within 60 days of receiving the COVID vaccine series"
	"1152674-1"	"1152674-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient hospitalized with shortness of breath"
	"1155752-1"	"1155752-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient death within 60 days of receiving a COVID vaccine"
	"1156224-1"	"1156224-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient has a renal transplant; developed fever and seen in Emergency Ctr.; tested positive for COVID."
	"1156224-1"	"1156224-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"Patient has a renal transplant; developed fever and seen in Emergency Ctr.; tested positive for COVID."
	"1156224-1"	"1156224-1"	"SARS-COV-2 ANTIBODY TEST POSITIVE"	"10084491"	"65-79 years"	"65-79"	"Patient has a renal transplant; developed fever and seen in Emergency Ctr.; tested positive for COVID."
	"1156845-1"	"1156845-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received COVID vaccine 3/23/2021.   The family called the vaccination clinic to inform that the patient died on 3/27/2021.   Family believes the vaccine caused the death.  I have no other information on this chart."
	"1160713-1"	"1160713-1"	"ACTIVATED PARTIAL THROMBOPLASTIN TIME PROLONGED"	"10000636"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"ANGIOGRAM ABNORMAL"	"10060956"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"ASPIRATION"	"10003504"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"ATELECTASIS"	"10003598"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"BLOOD CULTURE"	"10005485"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"BLOOD LACTIC ACID INCREASED"	"10005635"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"BRAIN INJURY"	"10067967"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"BRAIN NATRIURETIC PEPTIDE INCREASED"	"10053405"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"BREATH SOUNDS ABSENT"	"10062285"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"BRONCHOSCOPY ABNORMAL"	"10006480"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"CHEST WALL HAEMATOMA"	"10076597"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"CHEST X-RAY NORMAL"	"10008500"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"CHOLELITHIASIS"	"10008629"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"COAGULOPATHY"	"10009802"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"COMPUTERISED TOMOGRAM ABDOMEN"	"10053876"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"COMPUTERISED TOMOGRAM ABNORMAL"	"10010235"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"COMPUTERISED TOMOGRAM HEAD NORMAL"	"10072167"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"COMPUTERISED TOMOGRAM THORAX"	"10053875"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"ELECTROENCEPHALOGRAM ABNORMAL"	"10014408"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"HAEMOGLOBIN DECREASED"	"10018884"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"HAEMORRHAGE"	"10055798"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"HAEMOTHORAX"	"10019027"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"HEPATIC ENZYME INCREASED"	"10060795"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"INTERNATIONAL NORMALISED RATIO INCREASED"	"10022595"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"LUNG INFILTRATION"	"10025102"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"LUNG OPACITY"	"10081792"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"MAGNETIC RESONANCE IMAGING HEAD ABNORMAL"	"10085256"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"MEDIASTINAL HAEMATOMA"	"10049941"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"MYDRIASIS"	"10028521"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"NITRITE URINE PRESENT"	"10051469"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"PROTEIN URINE PRESENT"	"10053123"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"PULMONARY HYPERTENSION"	"10037400"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"PULMONARY OEDEMA"	"10037423"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"PULSE ABSENT"	"10037469"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"PULSELESS ELECTRICAL ACTIVITY"	"10058151"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"PUPIL FIXED"	"10037515"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"RIB FRACTURE"	"10039117"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"SEIZURE"	"10039906"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"STATUS EPILEPTICUS"	"10041962"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"STERNAL FRACTURE"	"10042015"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"THROMBOSIS"	"10043607"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"TRANSFUSION"	"10066152"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"TROPONIN INCREASED"	"10058267"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160713-1"	"1160713-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cardiac arrest (HCC) [I46.9]   HOSPITAL COURSE: Patient is a 74 year old female who receives care through healthcare clinic and second healthcare clinic with past medical history of HTN, CKD, cardiomyopathy/congestive heart failure, atrial fibrillation on Pradaxa who presented to the ED 3/16 after suffering an out of hospital cardiac arrest at her dentist's office. Per report, patient had SBP in the 80s on arrival but was asymptomatic. Prior to start of any procedure (no reports of being given sedative medications), she became unresponsive. CPR was initiated and was found to be in asystole. She received 3 rounds of CPR with ROSC. CT head without acute abnormality. Chest XR showing mild vascular congestion and interstitial edema. Initial labs showing AKI, elevated liver enzymes, BNP >29,000, troponin 39, lactic acid of 11, INR of 6.6, PTT 62, APTT 87. UA with protein, nitrite, moderate blood. Urine culture ordered. Blood cultures ordered. In ED, patient was hypotensive requiring addition of vasopressors. Targeted temperature management was started. Ceftriaxone and flagyl started for possible urinary tract infection and aspiration. Patient with profound coagulopathy, INR increasing to 12.0 on arrival to the ICU. Two units FFP and vitamin K were given. Patient with escalating pressor requirements at this time so CT t/a/p was ordered showing multiple bilateral rib fractures, nondisplaced sternal fracture with small anterior mediastinal retrosternal hematoma, small right sided hemothorax, right chest wall hematoma, patchy bilateral airspace disease consistent with atelectasis/infiltrate/aspiration, diffuse GGO consistent with interstitial edema, enlarged pulmonary arteries consistent with pulmonary hypertension, cholelithiasis. FDP elevated and 2 units of cryoprecipitate given 3/16. Hemoglobin decreased to 5.9 3/17 with INR of 5.4. Two additional units of FFP and additional dose of vitamin K ordered. Two units RBCs ordered. CTA thorax and abdomen 3/17 re-confirmed hemothorax and chest wall hematoma but no active bleeding noted. CT bilateral LE showed no evidence of hematoma. Trauma consulted who recommended chest tube placement. Overnight 3/16-3/17, patient also noted to have seizure activity on EEG and patient loaded with Keppra. Head CT 3/17 negative for hemorrhage or other acute processes. Patient remained in status epilepticus 3/17am and additional Keppra load was given and neurology consulted. Received Praxbind for continued bleeding/coagulopathy. 3/17pm went into PEA arrest with 10 minutes of CPR with ROSC. Bronchoscopy following ROSC noted evidence of bleeding from multiple areas, clots removed. MRI brain showing diffuse anoxic brain injury. Propofol stopped 3/19am.   After goals of care discussion this morning, all first degree relatives (daughter and son) all in agreement to transition to comfort care measures. I received call from bedside RN that patient had passed away. On exam, no heart or breath sounds appreciated upon auscultation for 2 minutes. No spontaneous movement or chest rise noted. No pulse palpated for two minutes. Pupils fixed and dilated. No response to noxious stimuli. Time of death 1400 3/20/2021."
	"1160839-1"	"1160839-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Hospice patient death within 60 days of receiving the COVID vaccine series"
	"1162753-1"	"1162753-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Tongue swolle so large he had to be put on a vent for 10 days, passed away after 2 weeks"
	"1162753-1"	"1162753-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Tongue swolle so large he had to be put on a vent for 10 days, passed away after 2 weeks"
	"1162753-1"	"1162753-1"	"SWOLLEN TONGUE"	"10042727"	"65-79 years"	"65-79"	"Tongue swolle so large he had to be put on a vent for 10 days, passed away after 2 weeks"
	"1167886-1"	"1167886-1"	"ANAEMIA"	"10002034"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"ASTHMA"	"10003553"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"BACTERIAL INFECTION"	"10060945"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"FIBRIN D DIMER INCREASED"	"10016581"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"PRODUCTIVE COUGH"	"10036790"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"TACHYCARDIA"	"10043071"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167886-1"	"1167886-1"	"TROPONIN INCREASED"	"10058267"	"65-79 years"	"65-79"	"Patient vaccinated against COVID-19; received COVID-19 Janssen vaccine on 3/10/2021.   Patient developed symptoms last week of March.  Called Provider with symptoms and then presented to the hospital (admitted on 4/1/2021).   Tested for COVID and found to be positive.  4/1/2021.  Patient declined, admitted to ICU on 4/3/2021.  Patient died on 4/4/2021.    Chief Complaint: HPI: Patient is a 79 y.o. yr. old female who presents today for COUGH (has had cough for a little over a week) and FEVER (on and off for about a week)Patient was seen due to feeling ill for over week.  Patient states that she was trying to fight it on her own but symptoms have been progressing.  Patient has felt feverish no known fevers.  Has had a persistent now worsening cough.  Patient is feeling very tired and weak due to being sick for over week.  Patient does live alone. Patient is coughing which is productive with sputum.   Patient is eating and drinking well.  No N/V/d.  No loss of taste or smell.   No recent ill exposure.;  Has had covid vaccine.  Patient did get the Johnson and Johnson vaccine over a month ago. Patient is feeling very fatigue; Having feverish/chills.   Patient is taking OTC nightquil which is no longer helping. Patient does see oncologist for her CLL.  DISCHARGE DIAGNOSIS: 1. Deceased 2. COVID-19 with hypoxia 3. Asthma 4. Anemia     DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE: Patient is a 79 year old female who was admitted on 04/01/2021 for COVID-19 pneumonia with complications of hypoxia.  Patient's symptoms of cough and shortness of breath have been present for approximately 2 weeks.  It was noted that 1 month ago she did receive the Johnson & Johnson vaccine.  Upon admission patient was treated with azithromycin, Rocephin to cover for secondary bacterial infection.  She was not a candidate for remdesivir due to the length of her symptoms.  She was started on  Decadron, as well as gentle fluids due to tachycardia for approximately 12 hours.  During the night of 4/2-4/3 patient progressively declined requiring more oxygen she was transferred to the intensive care unit.  Patient was a do not resuscitate continued decline and after exacerbating all treatment options patient was switched to comfort care earlier this evening.  Pronounced dead at 6:45 a.m."
	"1167899-1"	"1167899-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient death within 60 days of receiving the COVID vaccine series"
	"1168645-1"	"1168645-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient death within 60 days of receiving the COVID vaccine series"
	"1168691-1"	"1168691-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient death within 60 days of receiving the COVID vaccine series"
	"1176003-1"	"1176003-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient death within 60 days of receiving a COVID vaccine"
	"1180565-1"	"1180565-1"	"APHASIA"	"10002948"	"65-79 years"	"65-79"	"04/07/2021 cold hands, alternating hot and cold sweats, arm stiffness, shaking, aphasic and blank stare.  Date of death 04/07/2021."
	"1180565-1"	"1180565-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"04/07/2021 cold hands, alternating hot and cold sweats, arm stiffness, shaking, aphasic and blank stare.  Date of death 04/07/2021."
	"1180565-1"	"1180565-1"	"FEELING OF BODY TEMPERATURE CHANGE"	"10061458"	"65-79 years"	"65-79"	"04/07/2021 cold hands, alternating hot and cold sweats, arm stiffness, shaking, aphasic and blank stare.  Date of death 04/07/2021."
	"1180565-1"	"1180565-1"	"HYPERHIDROSIS"	"10020642"	"65-79 years"	"65-79"	"04/07/2021 cold hands, alternating hot and cold sweats, arm stiffness, shaking, aphasic and blank stare.  Date of death 04/07/2021."
	"1180565-1"	"1180565-1"	"MUSCULOSKELETAL STIFFNESS"	"10052904"	"65-79 years"	"65-79"	"04/07/2021 cold hands, alternating hot and cold sweats, arm stiffness, shaking, aphasic and blank stare.  Date of death 04/07/2021."
	"1180565-1"	"1180565-1"	"PERIPHERAL COLDNESS"	"10034568"	"65-79 years"	"65-79"	"04/07/2021 cold hands, alternating hot and cold sweats, arm stiffness, shaking, aphasic and blank stare.  Date of death 04/07/2021."
	"1180565-1"	"1180565-1"	"STARING"	"10041953"	"65-79 years"	"65-79"	"04/07/2021 cold hands, alternating hot and cold sweats, arm stiffness, shaking, aphasic and blank stare.  Date of death 04/07/2021."
	"1180565-1"	"1180565-1"	"TREMOR"	"10044565"	"65-79 years"	"65-79"	"04/07/2021 cold hands, alternating hot and cold sweats, arm stiffness, shaking, aphasic and blank stare.  Date of death 04/07/2021."
	"1184784-1"	"1184784-1"	"ABDOMINAL PAIN"	"10000081"	"65-79 years"	"65-79"	"Approximately 3 hours after vaccine administration, patient experienced the following: Nausea, Vomiting, Abdominal pain, and the following day: Bloody Bowel Movements. Patient went to the emergency department the day after vaccine administration. Patient was made NPO, started on IVF and Zosyn. Patient was seen by GI who agreed with supportive management of ischemic colitis. Around 1730 on 2/6, patient unresponsive and rapid response was called. Patient responded to Narcan. On 2/8/2021, 0358, patient was seen as not breathing and code blue was called. Interventions were unsuccessful and patient was pronounced dead at 0439am."
	"1184784-1"	"1184784-1"	"BLOOD LACTIC ACID"	"10005632"	"65-79 years"	"65-79"	"Approximately 3 hours after vaccine administration, patient experienced the following: Nausea, Vomiting, Abdominal pain, and the following day: Bloody Bowel Movements. Patient went to the emergency department the day after vaccine administration. Patient was made NPO, started on IVF and Zosyn. Patient was seen by GI who agreed with supportive management of ischemic colitis. Around 1730 on 2/6, patient unresponsive and rapid response was called. Patient responded to Narcan. On 2/8/2021, 0358, patient was seen as not breathing and code blue was called. Interventions were unsuccessful and patient was pronounced dead at 0439am."
	"1184784-1"	"1184784-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"65-79 years"	"65-79"	"Approximately 3 hours after vaccine administration, patient experienced the following: Nausea, Vomiting, Abdominal pain, and the following day: Bloody Bowel Movements. Patient went to the emergency department the day after vaccine administration. Patient was made NPO, started on IVF and Zosyn. Patient was seen by GI who agreed with supportive management of ischemic colitis. Around 1730 on 2/6, patient unresponsive and rapid response was called. Patient responded to Narcan. On 2/8/2021, 0358, patient was seen as not breathing and code blue was called. Interventions were unsuccessful and patient was pronounced dead at 0439am."
	"1184784-1"	"1184784-1"	"COLITIS ISCHAEMIC"	"10009895"	"65-79 years"	"65-79"	"Approximately 3 hours after vaccine administration, patient experienced the following: Nausea, Vomiting, Abdominal pain, and the following day: Bloody Bowel Movements. Patient went to the emergency department the day after vaccine administration. Patient was made NPO, started on IVF and Zosyn. Patient was seen by GI who agreed with supportive management of ischemic colitis. Around 1730 on 2/6, patient unresponsive and rapid response was called. Patient responded to Narcan. On 2/8/2021, 0358, patient was seen as not breathing and code blue was called. Interventions were unsuccessful and patient was pronounced dead at 0439am."
	"1184784-1"	"1184784-1"	"COMPUTERISED TOMOGRAM ABDOMEN ABNORMAL"	"10057798"	"65-79 years"	"65-79"	"Approximately 3 hours after vaccine administration, patient experienced the following: Nausea, Vomiting, Abdominal pain, and the following day: Bloody Bowel Movements. Patient went to the emergency department the day after vaccine administration. Patient was made NPO, started on IVF and Zosyn. Patient was seen by GI who agreed with supportive management of ischemic colitis. Around 1730 on 2/6, patient unresponsive and rapid response was called. Patient responded to Narcan. On 2/8/2021, 0358, patient was seen as not breathing and code blue was called. Interventions were unsuccessful and patient was pronounced dead at 0439am."
	"1184784-1"	"1184784-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Approximately 3 hours after vaccine administration, patient experienced the following: Nausea, Vomiting, Abdominal pain, and the following day: Bloody Bowel Movements. Patient went to the emergency department the day after vaccine administration. Patient was made NPO, started on IVF and Zosyn. Patient was seen by GI who agreed with supportive management of ischemic colitis. Around 1730 on 2/6, patient unresponsive and rapid response was called. Patient responded to Narcan. On 2/8/2021, 0358, patient was seen as not breathing and code blue was called. Interventions were unsuccessful and patient was pronounced dead at 0439am."
	"1184784-1"	"1184784-1"	"GASTROINTESTINAL WALL THICKENING"	"10075724"	"65-79 years"	"65-79"	"Approximately 3 hours after vaccine administration, patient experienced the following: Nausea, Vomiting, Abdominal pain, and the following day: Bloody Bowel Movements. Patient went to the emergency department the day after vaccine administration. Patient was made NPO, started on IVF and Zosyn. Patient was seen by GI who agreed with supportive management of ischemic colitis. Around 1730 on 2/6, patient unresponsive and rapid response was called. Patient responded to Narcan. On 2/8/2021, 0358, patient was seen as not breathing and code blue was called. Interventions were unsuccessful and patient was pronounced dead at 0439am."
	"1184784-1"	"1184784-1"	"HAEMATOCHEZIA"	"10018836"	"65-79 years"	"65-79"	"Approximately 3 hours after vaccine administration, patient experienced the following: Nausea, Vomiting, Abdominal pain, and the following day: Bloody Bowel Movements. Patient went to the emergency department the day after vaccine administration. Patient was made NPO, started on IVF and Zosyn. Patient was seen by GI who agreed with supportive management of ischemic colitis. Around 1730 on 2/6, patient unresponsive and rapid response was called. Patient responded to Narcan. On 2/8/2021, 0358, patient was seen as not breathing and code blue was called. Interventions were unsuccessful and patient was pronounced dead at 0439am."
	"1184784-1"	"1184784-1"	"HAEMOGLOBIN DECREASED"	"10018884"	"65-79 years"	"65-79"	"Approximately 3 hours after vaccine administration, patient experienced the following: Nausea, Vomiting, Abdominal pain, and the following day: Bloody Bowel Movements. Patient went to the emergency department the day after vaccine administration. Patient was made NPO, started on IVF and Zosyn. Patient was seen by GI who agreed with supportive management of ischemic colitis. Around 1730 on 2/6, patient unresponsive and rapid response was called. Patient responded to Narcan. On 2/8/2021, 0358, patient was seen as not breathing and code blue was called. Interventions were unsuccessful and patient was pronounced dead at 0439am."
	"1184784-1"	"1184784-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"Approximately 3 hours after vaccine administration, patient experienced the following: Nausea, Vomiting, Abdominal pain, and the following day: Bloody Bowel Movements. Patient went to the emergency department the day after vaccine administration. Patient was made NPO, started on IVF and Zosyn. Patient was seen by GI who agreed with supportive management of ischemic colitis. Around 1730 on 2/6, patient unresponsive and rapid response was called. Patient responded to Narcan. On 2/8/2021, 0358, patient was seen as not breathing and code blue was called. Interventions were unsuccessful and patient was pronounced dead at 0439am."
	"1184784-1"	"1184784-1"	"PNEUMATOSIS"	"10051986"	"65-79 years"	"65-79"	"Approximately 3 hours after vaccine administration, patient experienced the following: Nausea, Vomiting, Abdominal pain, and the following day: Bloody Bowel Movements. Patient went to the emergency department the day after vaccine administration. Patient was made NPO, started on IVF and Zosyn. Patient was seen by GI who agreed with supportive management of ischemic colitis. Around 1730 on 2/6, patient unresponsive and rapid response was called. Patient responded to Narcan. On 2/8/2021, 0358, patient was seen as not breathing and code blue was called. Interventions were unsuccessful and patient was pronounced dead at 0439am."
	"1184784-1"	"1184784-1"	"RESPIRATORY ARREST"	"10038669"	"65-79 years"	"65-79"	"Approximately 3 hours after vaccine administration, patient experienced the following: Nausea, Vomiting, Abdominal pain, and the following day: Bloody Bowel Movements. Patient went to the emergency department the day after vaccine administration. Patient was made NPO, started on IVF and Zosyn. Patient was seen by GI who agreed with supportive management of ischemic colitis. Around 1730 on 2/6, patient unresponsive and rapid response was called. Patient responded to Narcan. On 2/8/2021, 0358, patient was seen as not breathing and code blue was called. Interventions were unsuccessful and patient was pronounced dead at 0439am."
	"1184784-1"	"1184784-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"Approximately 3 hours after vaccine administration, patient experienced the following: Nausea, Vomiting, Abdominal pain, and the following day: Bloody Bowel Movements. Patient went to the emergency department the day after vaccine administration. Patient was made NPO, started on IVF and Zosyn. Patient was seen by GI who agreed with supportive management of ischemic colitis. Around 1730 on 2/6, patient unresponsive and rapid response was called. Patient responded to Narcan. On 2/8/2021, 0358, patient was seen as not breathing and code blue was called. Interventions were unsuccessful and patient was pronounced dead at 0439am."
	"1184784-1"	"1184784-1"	"WHITE BLOOD CELL COUNT INCREASED"	"10047943"	"65-79 years"	"65-79"	"Approximately 3 hours after vaccine administration, patient experienced the following: Nausea, Vomiting, Abdominal pain, and the following day: Bloody Bowel Movements. Patient went to the emergency department the day after vaccine administration. Patient was made NPO, started on IVF and Zosyn. Patient was seen by GI who agreed with supportive management of ischemic colitis. Around 1730 on 2/6, patient unresponsive and rapid response was called. Patient responded to Narcan. On 2/8/2021, 0358, patient was seen as not breathing and code blue was called. Interventions were unsuccessful and patient was pronounced dead at 0439am."
	"1185061-1"	"1185061-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	""On 04/08/2021 pt. was found passed away in her bath tub. Pt. received her 2nd dose of the Covid vaccine on 04/07/2021 at 2:00 p.m. Family choice not to have an autopsy performed and death certificate was completed with cause of death ""sudden cardiac arrest"".    Note on 2/20/21 Pt. was transferred to Hospital with dx. of acute pancreatitis with elevated lipase and wbc.""
	"1185061-1"	"1185061-1"	"LIPASE INCREASED"	"10024574"	"65-79 years"	"65-79"	""On 04/08/2021 pt. was found passed away in her bath tub. Pt. received her 2nd dose of the Covid vaccine on 04/07/2021 at 2:00 p.m. Family choice not to have an autopsy performed and death certificate was completed with cause of death ""sudden cardiac arrest"".    Note on 2/20/21 Pt. was transferred to Hospital with dx. of acute pancreatitis with elevated lipase and wbc.""
	"1185061-1"	"1185061-1"	"PANCREATITIS ACUTE"	"10033647"	"65-79 years"	"65-79"	""On 04/08/2021 pt. was found passed away in her bath tub. Pt. received her 2nd dose of the Covid vaccine on 04/07/2021 at 2:00 p.m. Family choice not to have an autopsy performed and death certificate was completed with cause of death ""sudden cardiac arrest"".    Note on 2/20/21 Pt. was transferred to Hospital with dx. of acute pancreatitis with elevated lipase and wbc.""
	"1185061-1"	"1185061-1"	"SUDDEN CARDIAC DEATH"	"10049418"	"65-79 years"	"65-79"	""On 04/08/2021 pt. was found passed away in her bath tub. Pt. received her 2nd dose of the Covid vaccine on 04/07/2021 at 2:00 p.m. Family choice not to have an autopsy performed and death certificate was completed with cause of death ""sudden cardiac arrest"".    Note on 2/20/21 Pt. was transferred to Hospital with dx. of acute pancreatitis with elevated lipase and wbc.""
	"1185061-1"	"1185061-1"	"WHITE BLOOD CELL COUNT INCREASED"	"10047943"	"65-79 years"	"65-79"	""On 04/08/2021 pt. was found passed away in her bath tub. Pt. received her 2nd dose of the Covid vaccine on 04/07/2021 at 2:00 p.m. Family choice not to have an autopsy performed and death certificate was completed with cause of death ""sudden cardiac arrest"".    Note on 2/20/21 Pt. was transferred to Hospital with dx. of acute pancreatitis with elevated lipase and wbc.""
	"1185193-1"	"1185193-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"within 2 weeks of receiving the covid vaccine patient became weak, stopped eating, more lethargic and became bedbound and was started on hospice. She died on 3/31/2021"
	"1185193-1"	"1185193-1"	"BEDRIDDEN"	"10048948"	"65-79 years"	"65-79"	"within 2 weeks of receiving the covid vaccine patient became weak, stopped eating, more lethargic and became bedbound and was started on hospice. She died on 3/31/2021"
	"1185193-1"	"1185193-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"within 2 weeks of receiving the covid vaccine patient became weak, stopped eating, more lethargic and became bedbound and was started on hospice. She died on 3/31/2021"
	"1185193-1"	"1185193-1"	"DECREASED APPETITE"	"10061428"	"65-79 years"	"65-79"	"within 2 weeks of receiving the covid vaccine patient became weak, stopped eating, more lethargic and became bedbound and was started on hospice. She died on 3/31/2021"
	"1185193-1"	"1185193-1"	"LETHARGY"	"10024264"	"65-79 years"	"65-79"	"within 2 weeks of receiving the covid vaccine patient became weak, stopped eating, more lethargic and became bedbound and was started on hospice. She died on 3/31/2021"
	"1192660-1"	"1192660-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"My father received the vaccine on Friday 3/5/21. He noted that he wasn?t feeling well following the vaccine. On 3/7/21, he passed away from a heart attack."
	"1192660-1"	"1192660-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"My father received the vaccine on Friday 3/5/21. He noted that he wasn?t feeling well following the vaccine. On 3/7/21, he passed away from a heart attack."
	"1192660-1"	"1192660-1"	"MYOCARDIAL INFARCTION"	"10028596"	"65-79 years"	"65-79"	"My father received the vaccine on Friday 3/5/21. He noted that he wasn?t feeling well following the vaccine. On 3/7/21, he passed away from a heart attack."
	"1198028-1"	"1198028-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"None stated."
	"1204272-1"	"1204272-1"	"BRAIN NATRIURETIC PEPTIDE INCREASED"	"10053405"	"65-79 years"	"65-79"	"Per EMS patient's husband reports she was using the push mower in the front yard and suddenly collapsed. EMS brought the patient in with active CPR in progress and the patient was pronounced deceased in the Emergency Department."
	"1204272-1"	"1204272-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Per EMS patient's husband reports she was using the push mower in the front yard and suddenly collapsed. EMS brought the patient in with active CPR in progress and the patient was pronounced deceased in the Emergency Department."
	"1204272-1"	"1204272-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Per EMS patient's husband reports she was using the push mower in the front yard and suddenly collapsed. EMS brought the patient in with active CPR in progress and the patient was pronounced deceased in the Emergency Department."
	"1204272-1"	"1204272-1"	"SYNCOPE"	"10042772"	"65-79 years"	"65-79"	"Per EMS patient's husband reports she was using the push mower in the front yard and suddenly collapsed. EMS brought the patient in with active CPR in progress and the patient was pronounced deceased in the Emergency Department."
	"1204272-1"	"1204272-1"	"TROPONIN"	"10061576"	"65-79 years"	"65-79"	"Per EMS patient's husband reports she was using the push mower in the front yard and suddenly collapsed. EMS brought the patient in with active CPR in progress and the patient was pronounced deceased in the Emergency Department."
	"1204876-1"	"1204876-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death"
	"1207863-1"	"1207863-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient death within 60 days of receiving the COVID vaccine series"
	"1208505-1"	"1208505-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away due to metastatic cancer in esophagus and liver."
	"1208505-1"	"1208505-1"	"HEPATIC CANCER METASTATIC"	"10055110"	"65-79 years"	"65-79"	"Patient passed away due to metastatic cancer in esophagus and liver."
	"1208505-1"	"1208505-1"	"OESOPHAGEAL CANCER METASTATIC"	"10055102"	"65-79 years"	"65-79"	"Patient passed away due to metastatic cancer in esophagus and liver."
	"1210133-1"	"1210133-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient had her Johnson and Johnson Covid 19 vaccine on Friday April 9, 2021. Prior to the vaccine patient displayed no noticeable signs of deteriorating health. Over the next two days, friends of the patient attempted to contact her with no success. Finally after several hours of no contact, the grandchildren of the patients friend went to her apartment and found the patient lying on the couch unresponsive. When the patient was found, her leg was swollen. She was cold and not breathing. She passed away after receiving the Johnson and Johnson vaccine."
	"1210133-1"	"1210133-1"	"NASOPHARYNGITIS"	"10028810"	"65-79 years"	"65-79"	"Patient had her Johnson and Johnson Covid 19 vaccine on Friday April 9, 2021. Prior to the vaccine patient displayed no noticeable signs of deteriorating health. Over the next two days, friends of the patient attempted to contact her with no success. Finally after several hours of no contact, the grandchildren of the patients friend went to her apartment and found the patient lying on the couch unresponsive. When the patient was found, her leg was swollen. She was cold and not breathing. She passed away after receiving the Johnson and Johnson vaccine."
	"1210133-1"	"1210133-1"	"PERIPHERAL SWELLING"	"10048959"	"65-79 years"	"65-79"	"Patient had her Johnson and Johnson Covid 19 vaccine on Friday April 9, 2021. Prior to the vaccine patient displayed no noticeable signs of deteriorating health. Over the next two days, friends of the patient attempted to contact her with no success. Finally after several hours of no contact, the grandchildren of the patients friend went to her apartment and found the patient lying on the couch unresponsive. When the patient was found, her leg was swollen. She was cold and not breathing. She passed away after receiving the Johnson and Johnson vaccine."
	"1210133-1"	"1210133-1"	"RESPIRATORY ARREST"	"10038669"	"65-79 years"	"65-79"	"Patient had her Johnson and Johnson Covid 19 vaccine on Friday April 9, 2021. Prior to the vaccine patient displayed no noticeable signs of deteriorating health. Over the next two days, friends of the patient attempted to contact her with no success. Finally after several hours of no contact, the grandchildren of the patients friend went to her apartment and found the patient lying on the couch unresponsive. When the patient was found, her leg was swollen. She was cold and not breathing. She passed away after receiving the Johnson and Johnson vaccine."
	"1210133-1"	"1210133-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"Patient had her Johnson and Johnson Covid 19 vaccine on Friday April 9, 2021. Prior to the vaccine patient displayed no noticeable signs of deteriorating health. Over the next two days, friends of the patient attempted to contact her with no success. Finally after several hours of no contact, the grandchildren of the patients friend went to her apartment and found the patient lying on the couch unresponsive. When the patient was found, her leg was swollen. She was cold and not breathing. She passed away after receiving the Johnson and Johnson vaccine."
	"1210673-1"	"1210673-1"	"BLOOD TEST"	"10061726"	"65-79 years"	"65-79"	"patient experienced a massive brain stem stroke on the morning of Friday, April 2, 2021. He was found minimally responsive on the floor at home and rushed to  Medical Center which has a comprehensive stroke center. Imaging and testing determined there was no chance of recovery that would restore meaningful quality of life. The family removed life support on Saturday, April 3, 2021.  Of note ,Patients sister, also, similarly suffered  mild stroke shortly after receiving her 2nd Pfizer COVID-19 vaccine. Her recovery is ongoing and her family has been encourage to also report to VAERS."
	"1210673-1"	"1210673-1"	"BRAIN STEM STROKE"	"10068644"	"65-79 years"	"65-79"	"patient experienced a massive brain stem stroke on the morning of Friday, April 2, 2021. He was found minimally responsive on the floor at home and rushed to  Medical Center which has a comprehensive stroke center. Imaging and testing determined there was no chance of recovery that would restore meaningful quality of life. The family removed life support on Saturday, April 3, 2021.  Of note ,Patients sister, also, similarly suffered  mild stroke shortly after receiving her 2nd Pfizer COVID-19 vaccine. Her recovery is ongoing and her family has been encourage to also report to VAERS."
	"1210673-1"	"1210673-1"	"COMPUTERISED TOMOGRAM ABNORMAL"	"10010235"	"65-79 years"	"65-79"	"patient experienced a massive brain stem stroke on the morning of Friday, April 2, 2021. He was found minimally responsive on the floor at home and rushed to  Medical Center which has a comprehensive stroke center. Imaging and testing determined there was no chance of recovery that would restore meaningful quality of life. The family removed life support on Saturday, April 3, 2021.  Of note ,Patients sister, also, similarly suffered  mild stroke shortly after receiving her 2nd Pfizer COVID-19 vaccine. Her recovery is ongoing and her family has been encourage to also report to VAERS."
	"1210673-1"	"1210673-1"	"ELECTROENCEPHALOGRAM ABNORMAL"	"10014408"	"65-79 years"	"65-79"	"patient experienced a massive brain stem stroke on the morning of Friday, April 2, 2021. He was found minimally responsive on the floor at home and rushed to  Medical Center which has a comprehensive stroke center. Imaging and testing determined there was no chance of recovery that would restore meaningful quality of life. The family removed life support on Saturday, April 3, 2021.  Of note ,Patients sister, also, similarly suffered  mild stroke shortly after receiving her 2nd Pfizer COVID-19 vaccine. Her recovery is ongoing and her family has been encourage to also report to VAERS."
	"1210673-1"	"1210673-1"	"HYPORESPONSIVE TO STIMULI"	"10071552"	"65-79 years"	"65-79"	"patient experienced a massive brain stem stroke on the morning of Friday, April 2, 2021. He was found minimally responsive on the floor at home and rushed to  Medical Center which has a comprehensive stroke center. Imaging and testing determined there was no chance of recovery that would restore meaningful quality of life. The family removed life support on Saturday, April 3, 2021.  Of note ,Patients sister, also, similarly suffered  mild stroke shortly after receiving her 2nd Pfizer COVID-19 vaccine. Her recovery is ongoing and her family has been encourage to also report to VAERS."
	"1210673-1"	"1210673-1"	"WITHDRAWAL OF LIFE SUPPORT"	"10067595"	"65-79 years"	"65-79"	"patient experienced a massive brain stem stroke on the morning of Friday, April 2, 2021. He was found minimally responsive on the floor at home and rushed to  Medical Center which has a comprehensive stroke center. Imaging and testing determined there was no chance of recovery that would restore meaningful quality of life. The family removed life support on Saturday, April 3, 2021.  Of note ,Patients sister, also, similarly suffered  mild stroke shortly after receiving her 2nd Pfizer COVID-19 vaccine. Her recovery is ongoing and her family has been encourage to also report to VAERS."
	"1215380-1"	"1215380-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"no symptoms"
	"1215401-1"	"1215401-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"PATIENT'S SISTER CALLED THIS AFTERNOON STATING HE HAD RECEIVED THE JANSSEN COVID VACCINE 4/05 AND THEY FOUND HIM DEAD THIS MORNING. THEY ARE NOT CERTAIN IF IT WAS FROM VACCINE. THEY CLAIM HE HAS NO OTHER HEALTH ISSUES AND IS NOT ON ANY OTHER MEDICATIONS. THEY HAVE NOT PERFORMED AUTOPSY. SHE WAS MORE RELAYING INFORMATION RATHER THAN BLAMING THE DEATH ON THE VACCINE. SHE REQUESTED WE SUBMIT REPORT TO VAERS; SHE HAS NO WAY TO AND DOES NOT KNOW HOW."
	"1217813-1"	"1217813-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"deceased on 4/13/21"
	"1220223-1"	"1220223-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"None stated."
	"1222020-1"	"1222020-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient became unresponsive in his chair at home. CPR was attempted by patients wife and paramedics without success. Patient is deceased."
	"1222020-1"	"1222020-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Patient became unresponsive in his chair at home. CPR was attempted by patients wife and paramedics without success. Patient is deceased."
	"1222020-1"	"1222020-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"Patient became unresponsive in his chair at home. CPR was attempted by patients wife and paramedics without success. Patient is deceased."
	"1232759-1"	"1232759-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"SAW OBITUARY FOR PATIENT IN PAPER SHE HAD JUST RECEIVED VACCINE NOT TO LONG AGO SO WANTED TO MAKE SURE THIS WAS REPORTED"
	"1233229-1"	"1233229-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient was hospitalized and died within 60 days of receiving a COVID vaccine series"
	"1233617-1"	"1233617-1"	"BLOOD CREATININE INCREASED"	"10005483"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"BLOOD GLUCOSE NORMAL"	"10005558"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"CARDIAC DISORDER"	"10061024"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"ECHOCARDIOGRAM ABNORMAL"	"10061593"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"FEELING ABNORMAL"	"10016322"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"HAEMOGLOBIN DECREASED"	"10018884"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"HEART INJURY"	"10061200"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"ILLNESS"	"10080284"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"LIVER FUNCTION TEST INCREASED"	"10077692"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"MULTIPLE ORGAN DYSFUNCTION SYNDROME"	"10077361"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"RENAL IMPAIRMENT"	"10062237"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"SEDATION"	"10039897"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"TROPONIN INCREASED"	"10058267"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1233617-1"	"1233617-1"	"WHITE BLOOD CELL COUNT NORMAL"	"10047944"	"65-79 years"	"65-79"	"5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter  asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death"
	"1237837-1"	"1237837-1"	"CONFUSIONAL STATE"	"10010305"	"65-79 years"	"65-79"	"This is a possible breakthrough COVID case. The patient had right-sided weakness for two weeks prior to 4/20/21. She then developed weakness and confusion in the few days leading up to hospitalization on 4/20/21. The patient tested positive for COVID on 4/20/21. The patient was also previously COVID positive on 11/6/2020."
	"1237837-1"	"1237837-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"This is a possible breakthrough COVID case. The patient had right-sided weakness for two weeks prior to 4/20/21. She then developed weakness and confusion in the few days leading up to hospitalization on 4/20/21. The patient tested positive for COVID on 4/20/21. The patient was also previously COVID positive on 11/6/2020."
	"1237837-1"	"1237837-1"	"HEMIPARESIS"	"10019465"	"65-79 years"	"65-79"	"This is a possible breakthrough COVID case. The patient had right-sided weakness for two weeks prior to 4/20/21. She then developed weakness and confusion in the few days leading up to hospitalization on 4/20/21. The patient tested positive for COVID on 4/20/21. The patient was also previously COVID positive on 11/6/2020."
	"1237837-1"	"1237837-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"This is a possible breakthrough COVID case. The patient had right-sided weakness for two weeks prior to 4/20/21. She then developed weakness and confusion in the few days leading up to hospitalization on 4/20/21. The patient tested positive for COVID on 4/20/21. The patient was also previously COVID positive on 11/6/2020."
	"1238123-1"	"1238123-1"	"ARTHRALGIA"	"10003239"	"65-79 years"	"65-79"	"4/14-Resident c/o not feeling well and  declined scheduled dialysis. c/o bilateral shoulder pain and fatigue. AP- 44, BP- 80/45, c/o headache, no chest pain and no SOB.  Sent to CMC ER- patient deceased on 4/14/2021."
	"1238123-1"	"1238123-1"	"BLOOD CALCIUM NORMAL"	"10005397"	"65-79 years"	"65-79"	"4/14-Resident c/o not feeling well and  declined scheduled dialysis. c/o bilateral shoulder pain and fatigue. AP- 44, BP- 80/45, c/o headache, no chest pain and no SOB.  Sent to CMC ER- patient deceased on 4/14/2021."
	"1238123-1"	"1238123-1"	"BLOOD CHLORIDE DECREASED"	"10005419"	"65-79 years"	"65-79"	"4/14-Resident c/o not feeling well and  declined scheduled dialysis. c/o bilateral shoulder pain and fatigue. AP- 44, BP- 80/45, c/o headache, no chest pain and no SOB.  Sent to CMC ER- patient deceased on 4/14/2021."
	"1238123-1"	"1238123-1"	"BLOOD CREATININE INCREASED"	"10005483"	"65-79 years"	"65-79"	"4/14-Resident c/o not feeling well and  declined scheduled dialysis. c/o bilateral shoulder pain and fatigue. AP- 44, BP- 80/45, c/o headache, no chest pain and no SOB.  Sent to CMC ER- patient deceased on 4/14/2021."
	"1238123-1"	"1238123-1"	"BLOOD GLUCOSE INCREASED"	"10005557"	"65-79 years"	"65-79"	"4/14-Resident c/o not feeling well and  declined scheduled dialysis. c/o bilateral shoulder pain and fatigue. AP- 44, BP- 80/45, c/o headache, no chest pain and no SOB.  Sent to CMC ER- patient deceased on 4/14/2021."
	"1238123-1"	"1238123-1"	"BLOOD POTASSIUM INCREASED"	"10005725"	"65-79 years"	"65-79"	"4/14-Resident c/o not feeling well and  declined scheduled dialysis. c/o bilateral shoulder pain and fatigue. AP- 44, BP- 80/45, c/o headache, no chest pain and no SOB.  Sent to CMC ER- patient deceased on 4/14/2021."
	"1238123-1"	"1238123-1"	"BLOOD SODIUM DECREASED"	"10005802"	"65-79 years"	"65-79"	"4/14-Resident c/o not feeling well and  declined scheduled dialysis. c/o bilateral shoulder pain and fatigue. AP- 44, BP- 80/45, c/o headache, no chest pain and no SOB.  Sent to CMC ER- patient deceased on 4/14/2021."
	"1238123-1"	"1238123-1"	"BLOOD UREA INCREASED"	"10005851"	"65-79 years"	"65-79"	"4/14-Resident c/o not feeling well and  declined scheduled dialysis. c/o bilateral shoulder pain and fatigue. AP- 44, BP- 80/45, c/o headache, no chest pain and no SOB.  Sent to CMC ER- patient deceased on 4/14/2021."
	"1238123-1"	"1238123-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"4/14-Resident c/o not feeling well and  declined scheduled dialysis. c/o bilateral shoulder pain and fatigue. AP- 44, BP- 80/45, c/o headache, no chest pain and no SOB.  Sent to CMC ER- patient deceased on 4/14/2021."
	"1238123-1"	"1238123-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"4/14-Resident c/o not feeling well and  declined scheduled dialysis. c/o bilateral shoulder pain and fatigue. AP- 44, BP- 80/45, c/o headache, no chest pain and no SOB.  Sent to CMC ER- patient deceased on 4/14/2021."
	"1238123-1"	"1238123-1"	"HAEMATOCRIT DECREASED"	"10018838"	"65-79 years"	"65-79"	"4/14-Resident c/o not feeling well and  declined scheduled dialysis. c/o bilateral shoulder pain and fatigue. AP- 44, BP- 80/45, c/o headache, no chest pain and no SOB.  Sent to CMC ER- patient deceased on 4/14/2021."
	"1238123-1"	"1238123-1"	"HAEMOGLOBIN DECREASED"	"10018884"	"65-79 years"	"65-79"	"4/14-Resident c/o not feeling well and  declined scheduled dialysis. c/o bilateral shoulder pain and fatigue. AP- 44, BP- 80/45, c/o headache, no chest pain and no SOB.  Sent to CMC ER- patient deceased on 4/14/2021."
	"1238123-1"	"1238123-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	"4/14-Resident c/o not feeling well and  declined scheduled dialysis. c/o bilateral shoulder pain and fatigue. AP- 44, BP- 80/45, c/o headache, no chest pain and no SOB.  Sent to CMC ER- patient deceased on 4/14/2021."
	"1238123-1"	"1238123-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"4/14-Resident c/o not feeling well and  declined scheduled dialysis. c/o bilateral shoulder pain and fatigue. AP- 44, BP- 80/45, c/o headache, no chest pain and no SOB.  Sent to CMC ER- patient deceased on 4/14/2021."
	"1238123-1"	"1238123-1"	"PLATELET COUNT DECREASED"	"10035528"	"65-79 years"	"65-79"	"4/14-Resident c/o not feeling well and  declined scheduled dialysis. c/o bilateral shoulder pain and fatigue. AP- 44, BP- 80/45, c/o headache, no chest pain and no SOB.  Sent to CMC ER- patient deceased on 4/14/2021."
	"1238123-1"	"1238123-1"	"RED BLOOD CELL COUNT DECREASED"	"10038153"	"65-79 years"	"65-79"	"4/14-Resident c/o not feeling well and  declined scheduled dialysis. c/o bilateral shoulder pain and fatigue. AP- 44, BP- 80/45, c/o headache, no chest pain and no SOB.  Sent to CMC ER- patient deceased on 4/14/2021."
	"1241387-1"	"1241387-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"DEATH"
	"1241873-1"	"1241873-1"	"CEREBROVASCULAR ACCIDENT"	"10008190"	"65-79 years"	"65-79"	"Patient received her first dose of Pfizer vaccine on 4/1/21.  Patient has a stroke 4/6/21 and passed away on 4/10/21."
	"1241873-1"	"1241873-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received her first dose of Pfizer vaccine on 4/1/21.  Patient has a stroke 4/6/21 and passed away on 4/10/21."
	"1242950-1"	"1242950-1"	"BLOOD TEST"	"10061726"	"65-79 years"	"65-79"	"Receiver of vaccine was reported dead on 04-22-2021 TOD 0809 to Medical Examiner's Office Report # 052-EMF-79-21"
	"1242950-1"	"1242950-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Receiver of vaccine was reported dead on 04-22-2021 TOD 0809 to Medical Examiner's Office Report # 052-EMF-79-21"
	"1247315-1"	"1247315-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death less than 24 hours after vaccine administration"
	"1247318-1"	"1247318-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death"
	"1249748-1"	"1249748-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"At first my mother had a headache. Then My mother was feeling weak and could not breathe.  She continued to suffer so went to the doctor to get a check up but continued to suffer and finally died on 2/8/21 due to a couple of reasons which include hypertension"
	"1249748-1"	"1249748-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"At first my mother had a headache. Then My mother was feeling weak and could not breathe.  She continued to suffer so went to the doctor to get a check up but continued to suffer and finally died on 2/8/21 due to a couple of reasons which include hypertension"
	"1249748-1"	"1249748-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"At first my mother had a headache. Then My mother was feeling weak and could not breathe.  She continued to suffer so went to the doctor to get a check up but continued to suffer and finally died on 2/8/21 due to a couple of reasons which include hypertension"
	"1249748-1"	"1249748-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	"At first my mother had a headache. Then My mother was feeling weak and could not breathe.  She continued to suffer so went to the doctor to get a check up but continued to suffer and finally died on 2/8/21 due to a couple of reasons which include hypertension"
	"1249748-1"	"1249748-1"	"HYPERTENSION"	"10020772"	"65-79 years"	"65-79"	"At first my mother had a headache. Then My mother was feeling weak and could not breathe.  She continued to suffer so went to the doctor to get a check up but continued to suffer and finally died on 2/8/21 due to a couple of reasons which include hypertension"
	"1252137-1"	"1252137-1"	"CEREBROVASCULAR ACCIDENT"	"10008190"	"65-79 years"	"65-79"	"Stoke 6 days after vaccine. Death 5 days after stroke."
	"1252137-1"	"1252137-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Stoke 6 days after vaccine. Death 5 days after stroke."
	"1258858-1"	"1258858-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient died on 4/22/21.  Vaccinated with 2nd dose of Moderna on 3/31/21.  Vaccinated with Shingrix on 4/15/21."
	"1271243-1"	"1271243-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Symptoms of fever, nausea, and weakness started 3 days following vaccination. Denies any exposure to COVID positive person.  Presented to local emergency department on 3/27/21 with nausea, fever, chills, dizziness, and confusion. Due to patient's condition, he was transferred to larger facility for further management. Patient was admitted to hospital and subsequently transferred to ICU on 4/17/21. He was intubated at that time. Patient went into multisystem organ failure and died on 4/18/21."
	"1271243-1"	"1271243-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"Symptoms of fever, nausea, and weakness started 3 days following vaccination. Denies any exposure to COVID positive person.  Presented to local emergency department on 3/27/21 with nausea, fever, chills, dizziness, and confusion. Due to patient's condition, he was transferred to larger facility for further management. Patient was admitted to hospital and subsequently transferred to ICU on 4/17/21. He was intubated at that time. Patient went into multisystem organ failure and died on 4/18/21."
	"1271243-1"	"1271243-1"	"CONFUSIONAL STATE"	"10010305"	"65-79 years"	"65-79"	"Symptoms of fever, nausea, and weakness started 3 days following vaccination. Denies any exposure to COVID positive person.  Presented to local emergency department on 3/27/21 with nausea, fever, chills, dizziness, and confusion. Due to patient's condition, he was transferred to larger facility for further management. Patient was admitted to hospital and subsequently transferred to ICU on 4/17/21. He was intubated at that time. Patient went into multisystem organ failure and died on 4/18/21."
	"1271243-1"	"1271243-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Symptoms of fever, nausea, and weakness started 3 days following vaccination. Denies any exposure to COVID positive person.  Presented to local emergency department on 3/27/21 with nausea, fever, chills, dizziness, and confusion. Due to patient's condition, he was transferred to larger facility for further management. Patient was admitted to hospital and subsequently transferred to ICU on 4/17/21. He was intubated at that time. Patient went into multisystem organ failure and died on 4/18/21."
	"1271243-1"	"1271243-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Symptoms of fever, nausea, and weakness started 3 days following vaccination. Denies any exposure to COVID positive person.  Presented to local emergency department on 3/27/21 with nausea, fever, chills, dizziness, and confusion. Due to patient's condition, he was transferred to larger facility for further management. Patient was admitted to hospital and subsequently transferred to ICU on 4/17/21. He was intubated at that time. Patient went into multisystem organ failure and died on 4/18/21."
	"1271243-1"	"1271243-1"	"DIZZINESS"	"10013573"	"65-79 years"	"65-79"	"Symptoms of fever, nausea, and weakness started 3 days following vaccination. Denies any exposure to COVID positive person.  Presented to local emergency department on 3/27/21 with nausea, fever, chills, dizziness, and confusion. Due to patient's condition, he was transferred to larger facility for further management. Patient was admitted to hospital and subsequently transferred to ICU on 4/17/21. He was intubated at that time. Patient went into multisystem organ failure and died on 4/18/21."
	"1271243-1"	"1271243-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Symptoms of fever, nausea, and weakness started 3 days following vaccination. Denies any exposure to COVID positive person.  Presented to local emergency department on 3/27/21 with nausea, fever, chills, dizziness, and confusion. Due to patient's condition, he was transferred to larger facility for further management. Patient was admitted to hospital and subsequently transferred to ICU on 4/17/21. He was intubated at that time. Patient went into multisystem organ failure and died on 4/18/21."
	"1271243-1"	"1271243-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Symptoms of fever, nausea, and weakness started 3 days following vaccination. Denies any exposure to COVID positive person.  Presented to local emergency department on 3/27/21 with nausea, fever, chills, dizziness, and confusion. Due to patient's condition, he was transferred to larger facility for further management. Patient was admitted to hospital and subsequently transferred to ICU on 4/17/21. He was intubated at that time. Patient went into multisystem organ failure and died on 4/18/21."
	"1271243-1"	"1271243-1"	"MULTIPLE ORGAN DYSFUNCTION SYNDROME"	"10077361"	"65-79 years"	"65-79"	"Symptoms of fever, nausea, and weakness started 3 days following vaccination. Denies any exposure to COVID positive person.  Presented to local emergency department on 3/27/21 with nausea, fever, chills, dizziness, and confusion. Due to patient's condition, he was transferred to larger facility for further management. Patient was admitted to hospital and subsequently transferred to ICU on 4/17/21. He was intubated at that time. Patient went into multisystem organ failure and died on 4/18/21."
	"1271243-1"	"1271243-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"Symptoms of fever, nausea, and weakness started 3 days following vaccination. Denies any exposure to COVID positive person.  Presented to local emergency department on 3/27/21 with nausea, fever, chills, dizziness, and confusion. Due to patient's condition, he was transferred to larger facility for further management. Patient was admitted to hospital and subsequently transferred to ICU on 4/17/21. He was intubated at that time. Patient went into multisystem organ failure and died on 4/18/21."
	"1271243-1"	"1271243-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"Symptoms of fever, nausea, and weakness started 3 days following vaccination. Denies any exposure to COVID positive person.  Presented to local emergency department on 3/27/21 with nausea, fever, chills, dizziness, and confusion. Due to patient's condition, he was transferred to larger facility for further management. Patient was admitted to hospital and subsequently transferred to ICU on 4/17/21. He was intubated at that time. Patient went into multisystem organ failure and died on 4/18/21."
	"1271243-1"	"1271243-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Symptoms of fever, nausea, and weakness started 3 days following vaccination. Denies any exposure to COVID positive person.  Presented to local emergency department on 3/27/21 with nausea, fever, chills, dizziness, and confusion. Due to patient's condition, he was transferred to larger facility for further management. Patient was admitted to hospital and subsequently transferred to ICU on 4/17/21. He was intubated at that time. Patient went into multisystem organ failure and died on 4/18/21."
	"1271305-1"	"1271305-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death within 60 days of vaccine"
	"1273804-1"	"1273804-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"GI Hemorrhage Covid + Respiratory Failure"
	"1273804-1"	"1273804-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"GI Hemorrhage Covid + Respiratory Failure"
	"1273804-1"	"1273804-1"	"GASTROINTESTINAL HAEMORRHAGE"	"10017955"	"65-79 years"	"65-79"	"GI Hemorrhage Covid + Respiratory Failure"
	"1273804-1"	"1273804-1"	"RESPIRATORY FAILURE"	"10038695"	"65-79 years"	"65-79"	"GI Hemorrhage Covid + Respiratory Failure"
	"1280996-1"	"1280996-1"	"FEELING ABNORMAL"	"10016322"	"65-79 years"	"65-79"	"Had average Saturday at home, no illness. Layed in bed talking. Became nauseated, got up to vomit. Went back to bed, talking again. Said something wasn't right. Massive Heart Attack and Immediate Death. Police arrive in 2 minutes to begin CPR. Medic soon after. Efforts to resuscitate unsuccessful."
	"1280996-1"	"1280996-1"	"MYOCARDIAL INFARCTION"	"10028596"	"65-79 years"	"65-79"	"Had average Saturday at home, no illness. Layed in bed talking. Became nauseated, got up to vomit. Went back to bed, talking again. Said something wasn't right. Massive Heart Attack and Immediate Death. Police arrive in 2 minutes to begin CPR. Medic soon after. Efforts to resuscitate unsuccessful."
	"1280996-1"	"1280996-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"Had average Saturday at home, no illness. Layed in bed talking. Became nauseated, got up to vomit. Went back to bed, talking again. Said something wasn't right. Massive Heart Attack and Immediate Death. Police arrive in 2 minutes to begin CPR. Medic soon after. Efforts to resuscitate unsuccessful."
	"1280996-1"	"1280996-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Had average Saturday at home, no illness. Layed in bed talking. Became nauseated, got up to vomit. Went back to bed, talking again. Said something wasn't right. Massive Heart Attack and Immediate Death. Police arrive in 2 minutes to begin CPR. Medic soon after. Efforts to resuscitate unsuccessful."
	"1280996-1"	"1280996-1"	"SUDDEN DEATH"	"10042434"	"65-79 years"	"65-79"	"Had average Saturday at home, no illness. Layed in bed talking. Became nauseated, got up to vomit. Went back to bed, talking again. Said something wasn't right. Massive Heart Attack and Immediate Death. Police arrive in 2 minutes to begin CPR. Medic soon after. Efforts to resuscitate unsuccessful."
	"1280996-1"	"1280996-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"Had average Saturday at home, no illness. Layed in bed talking. Became nauseated, got up to vomit. Went back to bed, talking again. Said something wasn't right. Massive Heart Attack and Immediate Death. Police arrive in 2 minutes to begin CPR. Medic soon after. Efforts to resuscitate unsuccessful."
	"1282776-1"	"1282776-1"	"CEREBROVASCULAR ACCIDENT"	"10008190"	"65-79 years"	"65-79"	"March 22 had a stroke, admitted, respiratory entire time, then rec'd death certificated  Death Certificate"
	"1282776-1"	"1282776-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"March 22 had a stroke, admitted, respiratory entire time, then rec'd death certificated  Death Certificate"
	"1282776-1"	"1282776-1"	"RESPIRATORY DISORDER"	"10038683"	"65-79 years"	"65-79"	"March 22 had a stroke, admitted, respiratory entire time, then rec'd death certificated  Death Certificate"
	"1285561-1"	"1285561-1"	"ACUTE MYOCARDIAL INFARCTION"	"10000891"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"ANTICOAGULANT THERAPY"	"10053468"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"ARTHRALGIA"	"10003239"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"BILEVEL POSITIVE AIRWAY PRESSURE"	"10064530"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"BLOOD MAGNESIUM NORMAL"	"10005656"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"CARDIOVERSION"	"10007661"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"CATHETERISATION CARDIAC"	"10007815"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"CHEST X-RAY NORMAL"	"10008500"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"CORONARY ARTERY DISEASE"	"10011078"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"CORONARY ARTERY OCCLUSION"	"10011086"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"EJECTION FRACTION DECREASED"	"10050528"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"ELECTROCARDIOGRAM ST SEGMENT DEPRESSION"	"10014391"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"FULL BLOOD COUNT"	"10017411"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"HAEMATOCRIT DECREASED"	"10018838"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"HAEMOGLOBIN DECREASED"	"10018884"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"LEFT VENTRICULAR DYSFUNCTION"	"10049694"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"MEAN CELL VOLUME INCREASED"	"10027004"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"METABOLIC FUNCTION TEST NORMAL"	"10062192"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"PAIN IN JAW"	"10033433"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"PULSE ABSENT"	"10037469"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"QRS AXIS ABNORMAL"	"10057624"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"RALES"	"10037833"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"RED BLOOD CELL COUNT DECREASED"	"10038153"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"TROPONIN INCREASED"	"10058267"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"VASCULAR GRAFT OCCLUSION"	"10049060"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"VASCULAR GRAFT THROMBOSIS"	"10069922"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1285561-1"	"1285561-1"	"VENTRICULAR TACHYCARDIA"	"10047302"	"65-79 years"	"65-79"	""The patient presented with chest pain around 5 pm on 4/4/21.  Patient reported ""pain came out of nowhere.""  Patient reported pain was non-exertional and non-positional.  He described it as ""a constant burning sensation"" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD.  Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on  a small dose nitroglycerine drip.  POX 70s, low 80s so Bipap ordered.  Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine.  Arrested in ICU.  Lines were placed by ICU team, arrested again in ICU.  Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2.  Moderately severe LV dysfunction with and EF 30% 3   The recent NSTEMI is secondary to the occlusion of the SVG-OM1.  There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4  The native OM1 is chronically occluded.  It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5.  Perclose""
	"1286232-1"	"1286232-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"patient passed away before second dose"
	"1286303-1"	"1286303-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"patient passed away"
	"1289387-1"	"1289387-1"	"COMPUTERISED TOMOGRAM HEAD ABNORMAL"	"10072168"	"65-79 years"	"65-79"	"Patient had a subarachnoid hemorrhage and died at hospital on the afternoon of saturday April 10"
	"1289387-1"	"1289387-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient had a subarachnoid hemorrhage and died at hospital on the afternoon of saturday April 10"
	"1289387-1"	"1289387-1"	"SUBARACHNOID HAEMORRHAGE"	"10042316"	"65-79 years"	"65-79"	"Patient had a subarachnoid hemorrhage and died at hospital on the afternoon of saturday April 10"
	"1290874-1"	"1290874-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Shortly after receiving this first dose,my husband's breathing went downhill, two months later he was dead. They could not find the cause. I told them I knew the cause. It was the Covid shot! I reported it to his pulmonologist and to the hospital staff. He was stable with all other conditions until he got this shot!"
	"1290874-1"	"1290874-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Shortly after receiving this first dose,my husband's breathing went downhill, two months later he was dead. They could not find the cause. I told them I knew the cause. It was the Covid shot! I reported it to his pulmonologist and to the hospital staff. He was stable with all other conditions until he got this shot!"
	"1290874-1"	"1290874-1"	"PNEUMONIA"	"10035664"	"65-79 years"	"65-79"	"Shortly after receiving this first dose,my husband's breathing went downhill, two months later he was dead. They could not find the cause. I told them I knew the cause. It was the Covid shot! I reported it to his pulmonologist and to the hospital staff. He was stable with all other conditions until he got this shot!"
	"1290874-1"	"1290874-1"	"PULMONARY FIBROSIS"	"10037383"	"65-79 years"	"65-79"	"Shortly after receiving this first dose,my husband's breathing went downhill, two months later he was dead. They could not find the cause. I told them I knew the cause. It was the Covid shot! I reported it to his pulmonologist and to the hospital staff. He was stable with all other conditions until he got this shot!"
	"1290874-1"	"1290874-1"	"RESPIRATION ABNORMAL"	"10038647"	"65-79 years"	"65-79"	"Shortly after receiving this first dose,my husband's breathing went downhill, two months later he was dead. They could not find the cause. I told them I knew the cause. It was the Covid shot! I reported it to his pulmonologist and to the hospital staff. He was stable with all other conditions until he got this shot!"
	"1296415-1"	"1296415-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"The nurse was called by the family letting us know that the patient had passed away at home.  No further details were provided,"
	"1301919-1"	"1301919-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death; This case was received via FDA VAERS on 04-May-2021 and was forwarded to Moderna on 04-May-2021.    This regulatory authority case was reported by an other health care professional (subsequently medically confirmed) and describes the occurrence of DEATH (Death) in a 76-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 008B21A) for COVID-19 vaccination.     No Medical History information was reported.   On 29-Mar-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on 01-Apr-2021 The patient died on 01-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed.        For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   Symptom Text : Death reported to Health department from Medical Examiner office, no further details provided Company comment:This is a 76-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 008B21A) who died 3 days after the second dose of vaccine. No Med history and no concomitant medication were provided. Very limited information has been reported at this time. Further information is not expected.; Sender's Comments: This is a 76-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 008B21A) who died 3 days after the second dose of vaccine. No Med hx and no conmeds were provided. Very limited information has been reported at this time. Further information is not expected.; Reported Cause(s) of Death: Unknown cause of death"
	"1302134-1"	"1302134-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Patient had several ED visits within 6 weeks of receiving COVID vaccination. He first presented to the ED on 4/8/21, was admitted on 4/9/21 for 2 days. He was admitted again on 4/20/21 for 6 days. He presented to the ED on 5/8/21 with cardiac arrest and died."
	"1302134-1"	"1302134-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient had several ED visits within 6 weeks of receiving COVID vaccination. He first presented to the ED on 4/8/21, was admitted on 4/9/21 for 2 days. He was admitted again on 4/20/21 for 6 days. He presented to the ED on 5/8/21 with cardiac arrest and died."
	"1303196-1"	"1303196-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"ANXIETY"	"10002855"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"BLOOD GASES ABNORMAL"	"10005539"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"CONSTIPATION"	"10010774"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"DYSPNOEA EXERTIONAL"	"10013971"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"DYSURIA"	"10013990"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"MAGNETIC RESONANCE IMAGING ABDOMINAL NORMAL"	"10083135"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"METABOLIC ACIDOSIS"	"10027417"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"RESPIRATORY ALKALOSIS"	"10038664"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"URINARY INCONTINENCE"	"10046543"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1303196-1"	"1303196-1"	"URINARY RETENTION"	"10046555"	"65-79 years"	"65-79"	""per medical report from hospital- ""presented to emergency room at outside facility secondary to worsening shortness of breath. The patient states that about 1 week ago she started feeling ill directly after receiving her first covid vaccine. the patient states her medical issues actually began approximately 2 months ago when she developed sudden onset positional urinary retention as well as urinary incontinence and constipation. She states that she thought maybe her known spinal stenosis had worsened causing her bladder dysfuntion.She states she tries to sit on a commode or a toilet and is unable to void however when lying flat she has to wear adult briefs as she has no control over her bladder at all. There is no p""
	"1307897-1"	"1307897-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	"The decedent experience nausea, headache, and chest pain approximately 72 hours after receieving her second shot.  She was found deceased later that day."
	"1307897-1"	"1307897-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"The decedent experience nausea, headache, and chest pain approximately 72 hours after receieving her second shot.  She was found deceased later that day."
	"1307897-1"	"1307897-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	"The decedent experience nausea, headache, and chest pain approximately 72 hours after receieving her second shot.  She was found deceased later that day."
	"1307897-1"	"1307897-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"The decedent experience nausea, headache, and chest pain approximately 72 hours after receieving her second shot.  She was found deceased later that day."
	"1313673-1"	"1313673-1"	"ANGIOGRAM PULMONARY ABNORMAL"	"10002441"	"65-79 years"	"65-79"	"4/2/21 Vaccination #2 given,  4/3 fatigue, decreased appetite and energy, increased confusion. 4/6/21 PCP   ordered  CT angiogram of chest-no PE but suspicious infiltrates in upper lung for Covid-19 pneumonia.  DVT negative. 4/7/21 Hospital ER CT of head/neck -no stenosis, no intercranial abnormalities, Covid test negative, RIDP positive for rhinovirus and entrovirus. Neuro consult, full admit. Treated with Rocephin, zithro and oxygen, eventually vented then transferred to another location on 4/11/21. Acutely ill and in shock, Extensive workup showed no other identifiable source of infection. Died 4/18/21."
	"1313673-1"	"1313673-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"4/2/21 Vaccination #2 given,  4/3 fatigue, decreased appetite and energy, increased confusion. 4/6/21 PCP   ordered  CT angiogram of chest-no PE but suspicious infiltrates in upper lung for Covid-19 pneumonia.  DVT negative. 4/7/21 Hospital ER CT of head/neck -no stenosis, no intercranial abnormalities, Covid test negative, RIDP positive for rhinovirus and entrovirus. Neuro consult, full admit. Treated with Rocephin, zithro and oxygen, eventually vented then transferred to another location on 4/11/21. Acutely ill and in shock, Extensive workup showed no other identifiable source of infection. Died 4/18/21."
	"1313673-1"	"1313673-1"	"COMPUTERISED TOMOGRAM HEAD NORMAL"	"10072167"	"65-79 years"	"65-79"	"4/2/21 Vaccination #2 given,  4/3 fatigue, decreased appetite and energy, increased confusion. 4/6/21 PCP   ordered  CT angiogram of chest-no PE but suspicious infiltrates in upper lung for Covid-19 pneumonia.  DVT negative. 4/7/21 Hospital ER CT of head/neck -no stenosis, no intercranial abnormalities, Covid test negative, RIDP positive for rhinovirus and entrovirus. Neuro consult, full admit. Treated with Rocephin, zithro and oxygen, eventually vented then transferred to another location on 4/11/21. Acutely ill and in shock, Extensive workup showed no other identifiable source of infection. Died 4/18/21."
	"1313673-1"	"1313673-1"	"COMPUTERISED TOMOGRAM NECK"	"10082961"	"65-79 years"	"65-79"	"4/2/21 Vaccination #2 given,  4/3 fatigue, decreased appetite and energy, increased confusion. 4/6/21 PCP   ordered  CT angiogram of chest-no PE but suspicious infiltrates in upper lung for Covid-19 pneumonia.  DVT negative. 4/7/21 Hospital ER CT of head/neck -no stenosis, no intercranial abnormalities, Covid test negative, RIDP positive for rhinovirus and entrovirus. Neuro consult, full admit. Treated with Rocephin, zithro and oxygen, eventually vented then transferred to another location on 4/11/21. Acutely ill and in shock, Extensive workup showed no other identifiable source of infection. Died 4/18/21."
	"1313673-1"	"1313673-1"	"CONFUSIONAL STATE"	"10010305"	"65-79 years"	"65-79"	"4/2/21 Vaccination #2 given,  4/3 fatigue, decreased appetite and energy, increased confusion. 4/6/21 PCP   ordered  CT angiogram of chest-no PE but suspicious infiltrates in upper lung for Covid-19 pneumonia.  DVT negative. 4/7/21 Hospital ER CT of head/neck -no stenosis, no intercranial abnormalities, Covid test negative, RIDP positive for rhinovirus and entrovirus. Neuro consult, full admit. Treated with Rocephin, zithro and oxygen, eventually vented then transferred to another location on 4/11/21. Acutely ill and in shock, Extensive workup showed no other identifiable source of infection. Died 4/18/21."
	"1313673-1"	"1313673-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"4/2/21 Vaccination #2 given,  4/3 fatigue, decreased appetite and energy, increased confusion. 4/6/21 PCP   ordered  CT angiogram of chest-no PE but suspicious infiltrates in upper lung for Covid-19 pneumonia.  DVT negative. 4/7/21 Hospital ER CT of head/neck -no stenosis, no intercranial abnormalities, Covid test negative, RIDP positive for rhinovirus and entrovirus. Neuro consult, full admit. Treated with Rocephin, zithro and oxygen, eventually vented then transferred to another location on 4/11/21. Acutely ill and in shock, Extensive workup showed no other identifiable source of infection. Died 4/18/21."
	"1313673-1"	"1313673-1"	"DECREASED APPETITE"	"10061428"	"65-79 years"	"65-79"	"4/2/21 Vaccination #2 given,  4/3 fatigue, decreased appetite and energy, increased confusion. 4/6/21 PCP   ordered  CT angiogram of chest-no PE but suspicious infiltrates in upper lung for Covid-19 pneumonia.  DVT negative. 4/7/21 Hospital ER CT of head/neck -no stenosis, no intercranial abnormalities, Covid test negative, RIDP positive for rhinovirus and entrovirus. Neuro consult, full admit. Treated with Rocephin, zithro and oxygen, eventually vented then transferred to another location on 4/11/21. Acutely ill and in shock, Extensive workup showed no other identifiable source of infection. Died 4/18/21."
	"1313673-1"	"1313673-1"	"ENTEROVIRUS TEST POSITIVE"	"10070386"	"65-79 years"	"65-79"	"4/2/21 Vaccination #2 given,  4/3 fatigue, decreased appetite and energy, increased confusion. 4/6/21 PCP   ordered  CT angiogram of chest-no PE but suspicious infiltrates in upper lung for Covid-19 pneumonia.  DVT negative. 4/7/21 Hospital ER CT of head/neck -no stenosis, no intercranial abnormalities, Covid test negative, RIDP positive for rhinovirus and entrovirus. Neuro consult, full admit. Treated with Rocephin, zithro and oxygen, eventually vented then transferred to another location on 4/11/21. Acutely ill and in shock, Extensive workup showed no other identifiable source of infection. Died 4/18/21."
	"1313673-1"	"1313673-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"4/2/21 Vaccination #2 given,  4/3 fatigue, decreased appetite and energy, increased confusion. 4/6/21 PCP   ordered  CT angiogram of chest-no PE but suspicious infiltrates in upper lung for Covid-19 pneumonia.  DVT negative. 4/7/21 Hospital ER CT of head/neck -no stenosis, no intercranial abnormalities, Covid test negative, RIDP positive for rhinovirus and entrovirus. Neuro consult, full admit. Treated with Rocephin, zithro and oxygen, eventually vented then transferred to another location on 4/11/21. Acutely ill and in shock, Extensive workup showed no other identifiable source of infection. Died 4/18/21."
	"1313673-1"	"1313673-1"	"HUMAN RHINOVIRUS TEST POSITIVE"	"10070249"	"65-79 years"	"65-79"	"4/2/21 Vaccination #2 given,  4/3 fatigue, decreased appetite and energy, increased confusion. 4/6/21 PCP   ordered  CT angiogram of chest-no PE but suspicious infiltrates in upper lung for Covid-19 pneumonia.  DVT negative. 4/7/21 Hospital ER CT of head/neck -no stenosis, no intercranial abnormalities, Covid test negative, RIDP positive for rhinovirus and entrovirus. Neuro consult, full admit. Treated with Rocephin, zithro and oxygen, eventually vented then transferred to another location on 4/11/21. Acutely ill and in shock, Extensive workup showed no other identifiable source of infection. Died 4/18/21."
	"1313673-1"	"1313673-1"	"ILLNESS"	"10080284"	"65-79 years"	"65-79"	"4/2/21 Vaccination #2 given,  4/3 fatigue, decreased appetite and energy, increased confusion. 4/6/21 PCP   ordered  CT angiogram of chest-no PE but suspicious infiltrates in upper lung for Covid-19 pneumonia.  DVT negative. 4/7/21 Hospital ER CT of head/neck -no stenosis, no intercranial abnormalities, Covid test negative, RIDP positive for rhinovirus and entrovirus. Neuro consult, full admit. Treated with Rocephin, zithro and oxygen, eventually vented then transferred to another location on 4/11/21. Acutely ill and in shock, Extensive workup showed no other identifiable source of infection. Died 4/18/21."
	"1313673-1"	"1313673-1"	"LUNG INFILTRATION"	"10025102"	"65-79 years"	"65-79"	"4/2/21 Vaccination #2 given,  4/3 fatigue, decreased appetite and energy, increased confusion. 4/6/21 PCP   ordered  CT angiogram of chest-no PE but suspicious infiltrates in upper lung for Covid-19 pneumonia.  DVT negative. 4/7/21 Hospital ER CT of head/neck -no stenosis, no intercranial abnormalities, Covid test negative, RIDP positive for rhinovirus and entrovirus. Neuro consult, full admit. Treated with Rocephin, zithro and oxygen, eventually vented then transferred to another location on 4/11/21. Acutely ill and in shock, Extensive workup showed no other identifiable source of infection. Died 4/18/21."
	"1313673-1"	"1313673-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"4/2/21 Vaccination #2 given,  4/3 fatigue, decreased appetite and energy, increased confusion. 4/6/21 PCP   ordered  CT angiogram of chest-no PE but suspicious infiltrates in upper lung for Covid-19 pneumonia.  DVT negative. 4/7/21 Hospital ER CT of head/neck -no stenosis, no intercranial abnormalities, Covid test negative, RIDP positive for rhinovirus and entrovirus. Neuro consult, full admit. Treated with Rocephin, zithro and oxygen, eventually vented then transferred to another location on 4/11/21. Acutely ill and in shock, Extensive workup showed no other identifiable source of infection. Died 4/18/21."
	"1313673-1"	"1313673-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	"4/2/21 Vaccination #2 given,  4/3 fatigue, decreased appetite and energy, increased confusion. 4/6/21 PCP   ordered  CT angiogram of chest-no PE but suspicious infiltrates in upper lung for Covid-19 pneumonia.  DVT negative. 4/7/21 Hospital ER CT of head/neck -no stenosis, no intercranial abnormalities, Covid test negative, RIDP positive for rhinovirus and entrovirus. Neuro consult, full admit. Treated with Rocephin, zithro and oxygen, eventually vented then transferred to another location on 4/11/21. Acutely ill and in shock, Extensive workup showed no other identifiable source of infection. Died 4/18/21."
	"1313673-1"	"1313673-1"	"SHOCK"	"10040560"	"65-79 years"	"65-79"	"4/2/21 Vaccination #2 given,  4/3 fatigue, decreased appetite and energy, increased confusion. 4/6/21 PCP   ordered  CT angiogram of chest-no PE but suspicious infiltrates in upper lung for Covid-19 pneumonia.  DVT negative. 4/7/21 Hospital ER CT of head/neck -no stenosis, no intercranial abnormalities, Covid test negative, RIDP positive for rhinovirus and entrovirus. Neuro consult, full admit. Treated with Rocephin, zithro and oxygen, eventually vented then transferred to another location on 4/11/21. Acutely ill and in shock, Extensive workup showed no other identifiable source of infection. Died 4/18/21."
	"1321835-1"	"1321835-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Almost immediated  weakness within 3 or four hours, collapsed the next day, repeated falls, taken to Emergency Room on Thursday, March 25, 2021--admitted to Heart Hospital with heart failure, lung failure ( no history of lung problems), and severe sepsis, placed on ventilator until Saturday, March 27, 2021.  Died on March 28, 2021."
	"1321835-1"	"1321835-1"	"CARDIAC FAILURE"	"10007554"	"65-79 years"	"65-79"	"Almost immediated  weakness within 3 or four hours, collapsed the next day, repeated falls, taken to Emergency Room on Thursday, March 25, 2021--admitted to Heart Hospital with heart failure, lung failure ( no history of lung problems), and severe sepsis, placed on ventilator until Saturday, March 27, 2021.  Died on March 28, 2021."
	"1321835-1"	"1321835-1"	"COMPUTERISED TOMOGRAM"	"10010234"	"65-79 years"	"65-79"	"Almost immediated  weakness within 3 or four hours, collapsed the next day, repeated falls, taken to Emergency Room on Thursday, March 25, 2021--admitted to Heart Hospital with heart failure, lung failure ( no history of lung problems), and severe sepsis, placed on ventilator until Saturday, March 27, 2021.  Died on March 28, 2021."
	"1321835-1"	"1321835-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Almost immediated  weakness within 3 or four hours, collapsed the next day, repeated falls, taken to Emergency Room on Thursday, March 25, 2021--admitted to Heart Hospital with heart failure, lung failure ( no history of lung problems), and severe sepsis, placed on ventilator until Saturday, March 27, 2021.  Died on March 28, 2021."
	"1321835-1"	"1321835-1"	"FALL"	"10016173"	"65-79 years"	"65-79"	"Almost immediated  weakness within 3 or four hours, collapsed the next day, repeated falls, taken to Emergency Room on Thursday, March 25, 2021--admitted to Heart Hospital with heart failure, lung failure ( no history of lung problems), and severe sepsis, placed on ventilator until Saturday, March 27, 2021.  Died on March 28, 2021."
	"1321835-1"	"1321835-1"	"IMMEDIATE POST-INJECTION REACTION"	"10067142"	"65-79 years"	"65-79"	"Almost immediated  weakness within 3 or four hours, collapsed the next day, repeated falls, taken to Emergency Room on Thursday, March 25, 2021--admitted to Heart Hospital with heart failure, lung failure ( no history of lung problems), and severe sepsis, placed on ventilator until Saturday, March 27, 2021.  Died on March 28, 2021."
	"1321835-1"	"1321835-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Almost immediated  weakness within 3 or four hours, collapsed the next day, repeated falls, taken to Emergency Room on Thursday, March 25, 2021--admitted to Heart Hospital with heart failure, lung failure ( no history of lung problems), and severe sepsis, placed on ventilator until Saturday, March 27, 2021.  Died on March 28, 2021."
	"1321835-1"	"1321835-1"	"RESPIRATORY FAILURE"	"10038695"	"65-79 years"	"65-79"	"Almost immediated  weakness within 3 or four hours, collapsed the next day, repeated falls, taken to Emergency Room on Thursday, March 25, 2021--admitted to Heart Hospital with heart failure, lung failure ( no history of lung problems), and severe sepsis, placed on ventilator until Saturday, March 27, 2021.  Died on March 28, 2021."
	"1321835-1"	"1321835-1"	"SEPSIS"	"10040047"	"65-79 years"	"65-79"	"Almost immediated  weakness within 3 or four hours, collapsed the next day, repeated falls, taken to Emergency Room on Thursday, March 25, 2021--admitted to Heart Hospital with heart failure, lung failure ( no history of lung problems), and severe sepsis, placed on ventilator until Saturday, March 27, 2021.  Died on March 28, 2021."
	"1321835-1"	"1321835-1"	"SYNCOPE"	"10042772"	"65-79 years"	"65-79"	"Almost immediated  weakness within 3 or four hours, collapsed the next day, repeated falls, taken to Emergency Room on Thursday, March 25, 2021--admitted to Heart Hospital with heart failure, lung failure ( no history of lung problems), and severe sepsis, placed on ventilator until Saturday, March 27, 2021.  Died on March 28, 2021."
	"1323372-1"	"1323372-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"Patient received both doses of Pfizer vaccine (#1 on 2/9/21, #2 on 3/2/21) and was fully vaccinated when he presented to the ED on 5/9/21 w/ 3 week h/o cough, shortness of breath,. Tested positive for COVID19 by PCR on 5/10/21. Patient treated w/ Remdesivir, Dexamethasone, and convalescent plasma. Was on ventilator. Expired on 5/16/21 due to Acute Respiratory Failure with Hypoxia, Pneumonia due to COVID-19."
	"1323372-1"	"1323372-1"	"CONVALESCENT PLASMA TRANSFUSION"	"10084817"	"65-79 years"	"65-79"	"Patient received both doses of Pfizer vaccine (#1 on 2/9/21, #2 on 3/2/21) and was fully vaccinated when he presented to the ED on 5/9/21 w/ 3 week h/o cough, shortness of breath,. Tested positive for COVID19 by PCR on 5/10/21. Patient treated w/ Remdesivir, Dexamethasone, and convalescent plasma. Was on ventilator. Expired on 5/16/21 due to Acute Respiratory Failure with Hypoxia, Pneumonia due to COVID-19."
	"1323372-1"	"1323372-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Patient received both doses of Pfizer vaccine (#1 on 2/9/21, #2 on 3/2/21) and was fully vaccinated when he presented to the ED on 5/9/21 w/ 3 week h/o cough, shortness of breath,. Tested positive for COVID19 by PCR on 5/10/21. Patient treated w/ Remdesivir, Dexamethasone, and convalescent plasma. Was on ventilator. Expired on 5/16/21 due to Acute Respiratory Failure with Hypoxia, Pneumonia due to COVID-19."
	"1323372-1"	"1323372-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient received both doses of Pfizer vaccine (#1 on 2/9/21, #2 on 3/2/21) and was fully vaccinated when he presented to the ED on 5/9/21 w/ 3 week h/o cough, shortness of breath,. Tested positive for COVID19 by PCR on 5/10/21. Patient treated w/ Remdesivir, Dexamethasone, and convalescent plasma. Was on ventilator. Expired on 5/16/21 due to Acute Respiratory Failure with Hypoxia, Pneumonia due to COVID-19."
	"1323372-1"	"1323372-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Patient received both doses of Pfizer vaccine (#1 on 2/9/21, #2 on 3/2/21) and was fully vaccinated when he presented to the ED on 5/9/21 w/ 3 week h/o cough, shortness of breath,. Tested positive for COVID19 by PCR on 5/10/21. Patient treated w/ Remdesivir, Dexamethasone, and convalescent plasma. Was on ventilator. Expired on 5/16/21 due to Acute Respiratory Failure with Hypoxia, Pneumonia due to COVID-19."
	"1323372-1"	"1323372-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received both doses of Pfizer vaccine (#1 on 2/9/21, #2 on 3/2/21) and was fully vaccinated when he presented to the ED on 5/9/21 w/ 3 week h/o cough, shortness of breath,. Tested positive for COVID19 by PCR on 5/10/21. Patient treated w/ Remdesivir, Dexamethasone, and convalescent plasma. Was on ventilator. Expired on 5/16/21 due to Acute Respiratory Failure with Hypoxia, Pneumonia due to COVID-19."
	"1323372-1"	"1323372-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient received both doses of Pfizer vaccine (#1 on 2/9/21, #2 on 3/2/21) and was fully vaccinated when he presented to the ED on 5/9/21 w/ 3 week h/o cough, shortness of breath,. Tested positive for COVID19 by PCR on 5/10/21. Patient treated w/ Remdesivir, Dexamethasone, and convalescent plasma. Was on ventilator. Expired on 5/16/21 due to Acute Respiratory Failure with Hypoxia, Pneumonia due to COVID-19."
	"1323372-1"	"1323372-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Patient received both doses of Pfizer vaccine (#1 on 2/9/21, #2 on 3/2/21) and was fully vaccinated when he presented to the ED on 5/9/21 w/ 3 week h/o cough, shortness of breath,. Tested positive for COVID19 by PCR on 5/10/21. Patient treated w/ Remdesivir, Dexamethasone, and convalescent plasma. Was on ventilator. Expired on 5/16/21 due to Acute Respiratory Failure with Hypoxia, Pneumonia due to COVID-19."
	"1323372-1"	"1323372-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Patient received both doses of Pfizer vaccine (#1 on 2/9/21, #2 on 3/2/21) and was fully vaccinated when he presented to the ED on 5/9/21 w/ 3 week h/o cough, shortness of breath,. Tested positive for COVID19 by PCR on 5/10/21. Patient treated w/ Remdesivir, Dexamethasone, and convalescent plasma. Was on ventilator. Expired on 5/16/21 due to Acute Respiratory Failure with Hypoxia, Pneumonia due to COVID-19."
	"1323372-1"	"1323372-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient received both doses of Pfizer vaccine (#1 on 2/9/21, #2 on 3/2/21) and was fully vaccinated when he presented to the ED on 5/9/21 w/ 3 week h/o cough, shortness of breath,. Tested positive for COVID19 by PCR on 5/10/21. Patient treated w/ Remdesivir, Dexamethasone, and convalescent plasma. Was on ventilator. Expired on 5/16/21 due to Acute Respiratory Failure with Hypoxia, Pneumonia due to COVID-19."
	"1323372-1"	"1323372-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"Patient received both doses of Pfizer vaccine (#1 on 2/9/21, #2 on 3/2/21) and was fully vaccinated when he presented to the ED on 5/9/21 w/ 3 week h/o cough, shortness of breath,. Tested positive for COVID19 by PCR on 5/10/21. Patient treated w/ Remdesivir, Dexamethasone, and convalescent plasma. Was on ventilator. Expired on 5/16/21 due to Acute Respiratory Failure with Hypoxia, Pneumonia due to COVID-19."
	"1327598-1"	"1327598-1"	"ANION GAP"	"10002522"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"BLOOD CALCIUM INCREASED"	"10005396"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"BLOOD CHLORIDE NORMAL"	"10005421"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"BLOOD CREATININE NORMAL"	"10005484"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"BLOOD GLUCOSE INCREASED"	"10005557"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"BLOOD MAGNESIUM INCREASED"	"10005655"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"BLOOD SODIUM NORMAL"	"10005804"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"BLOOD UREA INCREASED"	"10005851"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"BLOOD UREA NITROGEN/CREATININE RATIO"	"10059899"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"CARBON DIOXIDE DECREASED"	"10007223"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"CARDIOVERSION"	"10007661"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"COMA SCALE"	"10069708"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"FOAMING AT MOUTH"	"10062654"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"GLOMERULAR FILTRATION RATE NORMAL"	"10018361"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"HAEMATOCRIT INCREASED"	"10018840"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"HAEMOGLOBIN NORMAL"	"10018890"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"LIVEDO RETICULARIS"	"10024648"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"MOUTH HAEMORRHAGE"	"10028024"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"PLATELET COUNT NORMAL"	"10035530"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"PNEUMOTHORAX"	"10035759"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"PUPILLARY REFLEX IMPAIRED"	"10037532"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"TROPONIN"	"10061576"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"VENTRICULAR TACHYCARDIA"	"10047302"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1327598-1"	"1327598-1"	"WHITE BLOOD CELL COUNT INCREASED"	"10047943"	"65-79 years"	"65-79"	"EMS dispactched to scene of home with CPR in progress. Pt. was in VTACH and shocked X1, Epinephine X 2, Bicarb X 1. Return of circulation which was lost enroute to ED. CPR started again.  Blood/Frothy sputum noted from tube and mouth. pupils 3 mm, sluggish. mottled skin in exremities. Glasgow coma score of 3.  In the ED Epi, bicarb, Ketalar, Lasix, CaCL, norepi Pt. transfered by helicopter to  higher level of care,"
	"1330021-1"	"1330021-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Patient was vaccinated on 1/22/2021 and 2/12/2021 and had out of hospital cardiac arrest on 5/5/2021 where he was tested for COVID-19 and was positive.  He had previously tested negative on 4/19/2021."
	"1330021-1"	"1330021-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient was vaccinated on 1/22/2021 and 2/12/2021 and had out of hospital cardiac arrest on 5/5/2021 where he was tested for COVID-19 and was positive.  He had previously tested negative on 4/19/2021."
	"1330021-1"	"1330021-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient was vaccinated on 1/22/2021 and 2/12/2021 and had out of hospital cardiac arrest on 5/5/2021 where he was tested for COVID-19 and was positive.  He had previously tested negative on 4/19/2021."
	"1334284-1"	"1334284-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"According to patient's daughter, patient only complained of nausea the day of the immunization. Patient received 2nd dose of Moderna vaccine at 4:05pm and passed away around 8:30pm that same day per daughter's account. She had no pulse upon arrival to hospital. Autopsy was not performed."
	"1334284-1"	"1334284-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"According to patient's daughter, patient only complained of nausea the day of the immunization. Patient received 2nd dose of Moderna vaccine at 4:05pm and passed away around 8:30pm that same day per daughter's account. She had no pulse upon arrival to hospital. Autopsy was not performed."
	"1334284-1"	"1334284-1"	"PULSE ABSENT"	"10037469"	"65-79 years"	"65-79"	"According to patient's daughter, patient only complained of nausea the day of the immunization. Patient received 2nd dose of Moderna vaccine at 4:05pm and passed away around 8:30pm that same day per daughter's account. She had no pulse upon arrival to hospital. Autopsy was not performed."
	"1337918-1"	"1337918-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Unaware of any adverse events between administration and death. Reporting agency became aware of patient's expiration on 05/14/2021."
	"1338617-1"	"1338617-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death of patient two days after second injection."
	"1347172-1"	"1347172-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Unexpected Death"
	"1350978-1"	"1350978-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"78y.o. male with a past medical history of COPD, DM II, and HTN who presented to the hospital's emergency department from an extended care facility. Patient was recently hospitalized and treated with IV antibiotics for HCAP. Patient tested positive for COVID on 3/24/2021. EKG was negative for ischemic signs but patient had an elevated troponin. CXR showed right pleural effusion. Patient was admitted with COVID-19 pneumonia and severe respiratory failure.  Patient's oxygenation continued to deteriorate despite Remdesivir, decadron and lovenox.  Patient went into respiratory failure and expired from progressive respiratory failure."
	"1350978-1"	"1350978-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"78y.o. male with a past medical history of COPD, DM II, and HTN who presented to the hospital's emergency department from an extended care facility. Patient was recently hospitalized and treated with IV antibiotics for HCAP. Patient tested positive for COVID on 3/24/2021. EKG was negative for ischemic signs but patient had an elevated troponin. CXR showed right pleural effusion. Patient was admitted with COVID-19 pneumonia and severe respiratory failure.  Patient's oxygenation continued to deteriorate despite Remdesivir, decadron and lovenox.  Patient went into respiratory failure and expired from progressive respiratory failure."
	"1350978-1"	"1350978-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"78y.o. male with a past medical history of COPD, DM II, and HTN who presented to the hospital's emergency department from an extended care facility. Patient was recently hospitalized and treated with IV antibiotics for HCAP. Patient tested positive for COVID on 3/24/2021. EKG was negative for ischemic signs but patient had an elevated troponin. CXR showed right pleural effusion. Patient was admitted with COVID-19 pneumonia and severe respiratory failure.  Patient's oxygenation continued to deteriorate despite Remdesivir, decadron and lovenox.  Patient went into respiratory failure and expired from progressive respiratory failure."
	"1350978-1"	"1350978-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"78y.o. male with a past medical history of COPD, DM II, and HTN who presented to the hospital's emergency department from an extended care facility. Patient was recently hospitalized and treated with IV antibiotics for HCAP. Patient tested positive for COVID on 3/24/2021. EKG was negative for ischemic signs but patient had an elevated troponin. CXR showed right pleural effusion. Patient was admitted with COVID-19 pneumonia and severe respiratory failure.  Patient's oxygenation continued to deteriorate despite Remdesivir, decadron and lovenox.  Patient went into respiratory failure and expired from progressive respiratory failure."
	"1350978-1"	"1350978-1"	"ELECTROCARDIOGRAM NORMAL"	"10014373"	"65-79 years"	"65-79"	"78y.o. male with a past medical history of COPD, DM II, and HTN who presented to the hospital's emergency department from an extended care facility. Patient was recently hospitalized and treated with IV antibiotics for HCAP. Patient tested positive for COVID on 3/24/2021. EKG was negative for ischemic signs but patient had an elevated troponin. CXR showed right pleural effusion. Patient was admitted with COVID-19 pneumonia and severe respiratory failure.  Patient's oxygenation continued to deteriorate despite Remdesivir, decadron and lovenox.  Patient went into respiratory failure and expired from progressive respiratory failure."
	"1350978-1"	"1350978-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"78y.o. male with a past medical history of COPD, DM II, and HTN who presented to the hospital's emergency department from an extended care facility. Patient was recently hospitalized and treated with IV antibiotics for HCAP. Patient tested positive for COVID on 3/24/2021. EKG was negative for ischemic signs but patient had an elevated troponin. CXR showed right pleural effusion. Patient was admitted with COVID-19 pneumonia and severe respiratory failure.  Patient's oxygenation continued to deteriorate despite Remdesivir, decadron and lovenox.  Patient went into respiratory failure and expired from progressive respiratory failure."
	"1350978-1"	"1350978-1"	"PLEURAL EFFUSION"	"10035598"	"65-79 years"	"65-79"	"78y.o. male with a past medical history of COPD, DM II, and HTN who presented to the hospital's emergency department from an extended care facility. Patient was recently hospitalized and treated with IV antibiotics for HCAP. Patient tested positive for COVID on 3/24/2021. EKG was negative for ischemic signs but patient had an elevated troponin. CXR showed right pleural effusion. Patient was admitted with COVID-19 pneumonia and severe respiratory failure.  Patient's oxygenation continued to deteriorate despite Remdesivir, decadron and lovenox.  Patient went into respiratory failure and expired from progressive respiratory failure."
	"1350978-1"	"1350978-1"	"RESPIRATORY FAILURE"	"10038695"	"65-79 years"	"65-79"	"78y.o. male with a past medical history of COPD, DM II, and HTN who presented to the hospital's emergency department from an extended care facility. Patient was recently hospitalized and treated with IV antibiotics for HCAP. Patient tested positive for COVID on 3/24/2021. EKG was negative for ischemic signs but patient had an elevated troponin. CXR showed right pleural effusion. Patient was admitted with COVID-19 pneumonia and severe respiratory failure.  Patient's oxygenation continued to deteriorate despite Remdesivir, decadron and lovenox.  Patient went into respiratory failure and expired from progressive respiratory failure."
	"1350978-1"	"1350978-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"78y.o. male with a past medical history of COPD, DM II, and HTN who presented to the hospital's emergency department from an extended care facility. Patient was recently hospitalized and treated with IV antibiotics for HCAP. Patient tested positive for COVID on 3/24/2021. EKG was negative for ischemic signs but patient had an elevated troponin. CXR showed right pleural effusion. Patient was admitted with COVID-19 pneumonia and severe respiratory failure.  Patient's oxygenation continued to deteriorate despite Remdesivir, decadron and lovenox.  Patient went into respiratory failure and expired from progressive respiratory failure."
	"1350978-1"	"1350978-1"	"TROPONIN INCREASED"	"10058267"	"65-79 years"	"65-79"	"78y.o. male with a past medical history of COPD, DM II, and HTN who presented to the hospital's emergency department from an extended care facility. Patient was recently hospitalized and treated with IV antibiotics for HCAP. Patient tested positive for COVID on 3/24/2021. EKG was negative for ischemic signs but patient had an elevated troponin. CXR showed right pleural effusion. Patient was admitted with COVID-19 pneumonia and severe respiratory failure.  Patient's oxygenation continued to deteriorate despite Remdesivir, decadron and lovenox.  Patient went into respiratory failure and expired from progressive respiratory failure."
	"1351084-1"	"1351084-1"	"ACUTE RESPIRATORY DISTRESS SYNDROME"	"10001052"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351084-1"	"1351084-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351084-1"	"1351084-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351084-1"	"1351084-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351084-1"	"1351084-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351084-1"	"1351084-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351084-1"	"1351084-1"	"DYSPNOEA EXERTIONAL"	"10013971"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351084-1"	"1351084-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351084-1"	"1351084-1"	"EXPOSURE TO SARS-COV-2"	"10084456"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351084-1"	"1351084-1"	"INFLUENZA VIRUS TEST"	"10070715"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351084-1"	"1351084-1"	"LACTIC ACIDOSIS"	"10023676"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351084-1"	"1351084-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351084-1"	"1351084-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351084-1"	"1351084-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351084-1"	"1351084-1"	"RESPIRATORY DISTRESS"	"10038687"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351084-1"	"1351084-1"	"RESPIRATORY SYNCYTIAL VIRUS TEST"	"10068562"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351084-1"	"1351084-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"75 y/o female w/ PMH significant for COPD, diabetes, GERD, HLD, HTN, CAD, CVA who presented to the hospital ED on 4/2/21 for fever, dyspnea. Pt reports being exposed to COVID 1 week ago, her entire family at home had it. She called her PCP and was placed on multivitamins and prednisone taper when she became symptomatic ~3/27/21. Throughout the week, pt had worsening dyspnea, worse with exertion, as well as dry cough, fevers and chills. Reports her temperature was 102 at home. Pulse ox was 85% at home and pt was instructed to come into the ED. On arrival, O2 82% on RA and pt having some respiratory distress. Patient was intubated and placed on full vent support, but could not be extubated. Patient's diabetes continued to be uncontrolled because of IV steroid. Patient's lactic acidosis improved with IV hydration. Patient continued to be difficult to extubate because of COVID pneumonia with ARDS. Family opted for the patient to be transitioned to hospice care and comfort care. Expired on 4/26/2021."
	"1351119-1"	"1351119-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"Patient presented to the ED on 4/23/21 and was subsequently hospitalized for Acute on chronic respiratory failure with hypoxia and hypercapnia. Patient presented to the ED on 5/5/21 and was subsequently hospitalized for hypertensive urgency and CVA. Patient died on 5/9/21."
	"1351119-1"	"1351119-1"	"CEREBROVASCULAR ACCIDENT"	"10008190"	"65-79 years"	"65-79"	"Patient presented to the ED on 4/23/21 and was subsequently hospitalized for Acute on chronic respiratory failure with hypoxia and hypercapnia. Patient presented to the ED on 5/5/21 and was subsequently hospitalized for hypertensive urgency and CVA. Patient died on 5/9/21."
	"1351119-1"	"1351119-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient presented to the ED on 4/23/21 and was subsequently hospitalized for Acute on chronic respiratory failure with hypoxia and hypercapnia. Patient presented to the ED on 5/5/21 and was subsequently hospitalized for hypertensive urgency and CVA. Patient died on 5/9/21."
	"1351119-1"	"1351119-1"	"HYPERCAPNIA"	"10020591"	"65-79 years"	"65-79"	"Patient presented to the ED on 4/23/21 and was subsequently hospitalized for Acute on chronic respiratory failure with hypoxia and hypercapnia. Patient presented to the ED on 5/5/21 and was subsequently hospitalized for hypertensive urgency and CVA. Patient died on 5/9/21."
	"1351119-1"	"1351119-1"	"HYPERTENSIVE URGENCY"	"10058181"	"65-79 years"	"65-79"	"Patient presented to the ED on 4/23/21 and was subsequently hospitalized for Acute on chronic respiratory failure with hypoxia and hypercapnia. Patient presented to the ED on 5/5/21 and was subsequently hospitalized for hypertensive urgency and CVA. Patient died on 5/9/21."
	"1351119-1"	"1351119-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Patient presented to the ED on 4/23/21 and was subsequently hospitalized for Acute on chronic respiratory failure with hypoxia and hypercapnia. Patient presented to the ED on 5/5/21 and was subsequently hospitalized for hypertensive urgency and CVA. Patient died on 5/9/21."
	"1351207-1"	"1351207-1"	"ABSENCE OF IMMEDIATE TREATMENT RESPONSE"	"10081766"	"65-79 years"	"65-79"	"73 year old male with PMHx of AFib, CAD, and HTN who presents with c/o dyspnea that started 4/6/21. Patient states it got to the point where he could not walk in his house without severe dyspnea. States he was diagnosed with COVID-19 one week prior. Per chart review he was in our ER 4/3/21 and diagnosed with COVID-19. At the time he was 95% on room air. His only other symptom has been diarrhea. He states he received the Johnson and Johnson vaccine one month ago. He denies any dizziness, chest pain, abdominal pain, n/v, weakness, or numbness. In ER patient was hypoxic and improved only with BiPAP. Per chart review patient had cardiac arrest on 11/2020 for 17 minutes. He has a significant cardiac history consisting of stemi, fem-pop bypass surgery, PVD, CABG x4, AFib post ablation 2017, V-tach. He was started on therapy with steroids, anticoagulation, and Remdesivir. He failed to improve and had increasing oxygen requirements. He was eventually intubated. Due to failure to improve patient was made DNR and eventually expired."
	"1351207-1"	"1351207-1"	"ANTICOAGULANT THERAPY"	"10053468"	"65-79 years"	"65-79"	"73 year old male with PMHx of AFib, CAD, and HTN who presents with c/o dyspnea that started 4/6/21. Patient states it got to the point where he could not walk in his house without severe dyspnea. States he was diagnosed with COVID-19 one week prior. Per chart review he was in our ER 4/3/21 and diagnosed with COVID-19. At the time he was 95% on room air. His only other symptom has been diarrhea. He states he received the Johnson and Johnson vaccine one month ago. He denies any dizziness, chest pain, abdominal pain, n/v, weakness, or numbness. In ER patient was hypoxic and improved only with BiPAP. Per chart review patient had cardiac arrest on 11/2020 for 17 minutes. He has a significant cardiac history consisting of stemi, fem-pop bypass surgery, PVD, CABG x4, AFib post ablation 2017, V-tach. He was started on therapy with steroids, anticoagulation, and Remdesivir. He failed to improve and had increasing oxygen requirements. He was eventually intubated. Due to failure to improve patient was made DNR and eventually expired."
	"1351207-1"	"1351207-1"	"BILEVEL POSITIVE AIRWAY PRESSURE"	"10064530"	"65-79 years"	"65-79"	"73 year old male with PMHx of AFib, CAD, and HTN who presents with c/o dyspnea that started 4/6/21. Patient states it got to the point where he could not walk in his house without severe dyspnea. States he was diagnosed with COVID-19 one week prior. Per chart review he was in our ER 4/3/21 and diagnosed with COVID-19. At the time he was 95% on room air. His only other symptom has been diarrhea. He states he received the Johnson and Johnson vaccine one month ago. He denies any dizziness, chest pain, abdominal pain, n/v, weakness, or numbness. In ER patient was hypoxic and improved only with BiPAP. Per chart review patient had cardiac arrest on 11/2020 for 17 minutes. He has a significant cardiac history consisting of stemi, fem-pop bypass surgery, PVD, CABG x4, AFib post ablation 2017, V-tach. He was started on therapy with steroids, anticoagulation, and Remdesivir. He failed to improve and had increasing oxygen requirements. He was eventually intubated. Due to failure to improve patient was made DNR and eventually expired."
	"1351207-1"	"1351207-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"73 year old male with PMHx of AFib, CAD, and HTN who presents with c/o dyspnea that started 4/6/21. Patient states it got to the point where he could not walk in his house without severe dyspnea. States he was diagnosed with COVID-19 one week prior. Per chart review he was in our ER 4/3/21 and diagnosed with COVID-19. At the time he was 95% on room air. His only other symptom has been diarrhea. He states he received the Johnson and Johnson vaccine one month ago. He denies any dizziness, chest pain, abdominal pain, n/v, weakness, or numbness. In ER patient was hypoxic and improved only with BiPAP. Per chart review patient had cardiac arrest on 11/2020 for 17 minutes. He has a significant cardiac history consisting of stemi, fem-pop bypass surgery, PVD, CABG x4, AFib post ablation 2017, V-tach. He was started on therapy with steroids, anticoagulation, and Remdesivir. He failed to improve and had increasing oxygen requirements. He was eventually intubated. Due to failure to improve patient was made DNR and eventually expired."
	"1351207-1"	"1351207-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"73 year old male with PMHx of AFib, CAD, and HTN who presents with c/o dyspnea that started 4/6/21. Patient states it got to the point where he could not walk in his house without severe dyspnea. States he was diagnosed with COVID-19 one week prior. Per chart review he was in our ER 4/3/21 and diagnosed with COVID-19. At the time he was 95% on room air. His only other symptom has been diarrhea. He states he received the Johnson and Johnson vaccine one month ago. He denies any dizziness, chest pain, abdominal pain, n/v, weakness, or numbness. In ER patient was hypoxic and improved only with BiPAP. Per chart review patient had cardiac arrest on 11/2020 for 17 minutes. He has a significant cardiac history consisting of stemi, fem-pop bypass surgery, PVD, CABG x4, AFib post ablation 2017, V-tach. He was started on therapy with steroids, anticoagulation, and Remdesivir. He failed to improve and had increasing oxygen requirements. He was eventually intubated. Due to failure to improve patient was made DNR and eventually expired."
	"1351207-1"	"1351207-1"	"DIARRHOEA"	"10012735"	"65-79 years"	"65-79"	"73 year old male with PMHx of AFib, CAD, and HTN who presents with c/o dyspnea that started 4/6/21. Patient states it got to the point where he could not walk in his house without severe dyspnea. States he was diagnosed with COVID-19 one week prior. Per chart review he was in our ER 4/3/21 and diagnosed with COVID-19. At the time he was 95% on room air. His only other symptom has been diarrhea. He states he received the Johnson and Johnson vaccine one month ago. He denies any dizziness, chest pain, abdominal pain, n/v, weakness, or numbness. In ER patient was hypoxic and improved only with BiPAP. Per chart review patient had cardiac arrest on 11/2020 for 17 minutes. He has a significant cardiac history consisting of stemi, fem-pop bypass surgery, PVD, CABG x4, AFib post ablation 2017, V-tach. He was started on therapy with steroids, anticoagulation, and Remdesivir. He failed to improve and had increasing oxygen requirements. He was eventually intubated. Due to failure to improve patient was made DNR and eventually expired."
	"1351207-1"	"1351207-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"73 year old male with PMHx of AFib, CAD, and HTN who presents with c/o dyspnea that started 4/6/21. Patient states it got to the point where he could not walk in his house without severe dyspnea. States he was diagnosed with COVID-19 one week prior. Per chart review he was in our ER 4/3/21 and diagnosed with COVID-19. At the time he was 95% on room air. His only other symptom has been diarrhea. He states he received the Johnson and Johnson vaccine one month ago. He denies any dizziness, chest pain, abdominal pain, n/v, weakness, or numbness. In ER patient was hypoxic and improved only with BiPAP. Per chart review patient had cardiac arrest on 11/2020 for 17 minutes. He has a significant cardiac history consisting of stemi, fem-pop bypass surgery, PVD, CABG x4, AFib post ablation 2017, V-tach. He was started on therapy with steroids, anticoagulation, and Remdesivir. He failed to improve and had increasing oxygen requirements. He was eventually intubated. Due to failure to improve patient was made DNR and eventually expired."
	"1351207-1"	"1351207-1"	"DYSPNOEA EXERTIONAL"	"10013971"	"65-79 years"	"65-79"	"73 year old male with PMHx of AFib, CAD, and HTN who presents with c/o dyspnea that started 4/6/21. Patient states it got to the point where he could not walk in his house without severe dyspnea. States he was diagnosed with COVID-19 one week prior. Per chart review he was in our ER 4/3/21 and diagnosed with COVID-19. At the time he was 95% on room air. His only other symptom has been diarrhea. He states he received the Johnson and Johnson vaccine one month ago. He denies any dizziness, chest pain, abdominal pain, n/v, weakness, or numbness. In ER patient was hypoxic and improved only with BiPAP. Per chart review patient had cardiac arrest on 11/2020 for 17 minutes. He has a significant cardiac history consisting of stemi, fem-pop bypass surgery, PVD, CABG x4, AFib post ablation 2017, V-tach. He was started on therapy with steroids, anticoagulation, and Remdesivir. He failed to improve and had increasing oxygen requirements. He was eventually intubated. Due to failure to improve patient was made DNR and eventually expired."
	"1351207-1"	"1351207-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"73 year old male with PMHx of AFib, CAD, and HTN who presents with c/o dyspnea that started 4/6/21. Patient states it got to the point where he could not walk in his house without severe dyspnea. States he was diagnosed with COVID-19 one week prior. Per chart review he was in our ER 4/3/21 and diagnosed with COVID-19. At the time he was 95% on room air. His only other symptom has been diarrhea. He states he received the Johnson and Johnson vaccine one month ago. He denies any dizziness, chest pain, abdominal pain, n/v, weakness, or numbness. In ER patient was hypoxic and improved only with BiPAP. Per chart review patient had cardiac arrest on 11/2020 for 17 minutes. He has a significant cardiac history consisting of stemi, fem-pop bypass surgery, PVD, CABG x4, AFib post ablation 2017, V-tach. He was started on therapy with steroids, anticoagulation, and Remdesivir. He failed to improve and had increasing oxygen requirements. He was eventually intubated. Due to failure to improve patient was made DNR and eventually expired."
	"1351207-1"	"1351207-1"	"GAIT DISTURBANCE"	"10017577"	"65-79 years"	"65-79"	"73 year old male with PMHx of AFib, CAD, and HTN who presents with c/o dyspnea that started 4/6/21. Patient states it got to the point where he could not walk in his house without severe dyspnea. States he was diagnosed with COVID-19 one week prior. Per chart review he was in our ER 4/3/21 and diagnosed with COVID-19. At the time he was 95% on room air. His only other symptom has been diarrhea. He states he received the Johnson and Johnson vaccine one month ago. He denies any dizziness, chest pain, abdominal pain, n/v, weakness, or numbness. In ER patient was hypoxic and improved only with BiPAP. Per chart review patient had cardiac arrest on 11/2020 for 17 minutes. He has a significant cardiac history consisting of stemi, fem-pop bypass surgery, PVD, CABG x4, AFib post ablation 2017, V-tach. He was started on therapy with steroids, anticoagulation, and Remdesivir. He failed to improve and had increasing oxygen requirements. He was eventually intubated. Due to failure to improve patient was made DNR and eventually expired."
	"1351207-1"	"1351207-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"73 year old male with PMHx of AFib, CAD, and HTN who presents with c/o dyspnea that started 4/6/21. Patient states it got to the point where he could not walk in his house without severe dyspnea. States he was diagnosed with COVID-19 one week prior. Per chart review he was in our ER 4/3/21 and diagnosed with COVID-19. At the time he was 95% on room air. His only other symptom has been diarrhea. He states he received the Johnson and Johnson vaccine one month ago. He denies any dizziness, chest pain, abdominal pain, n/v, weakness, or numbness. In ER patient was hypoxic and improved only with BiPAP. Per chart review patient had cardiac arrest on 11/2020 for 17 minutes. He has a significant cardiac history consisting of stemi, fem-pop bypass surgery, PVD, CABG x4, AFib post ablation 2017, V-tach. He was started on therapy with steroids, anticoagulation, and Remdesivir. He failed to improve and had increasing oxygen requirements. He was eventually intubated. Due to failure to improve patient was made DNR and eventually expired."
	"1351207-1"	"1351207-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"73 year old male with PMHx of AFib, CAD, and HTN who presents with c/o dyspnea that started 4/6/21. Patient states it got to the point where he could not walk in his house without severe dyspnea. States he was diagnosed with COVID-19 one week prior. Per chart review he was in our ER 4/3/21 and diagnosed with COVID-19. At the time he was 95% on room air. His only other symptom has been diarrhea. He states he received the Johnson and Johnson vaccine one month ago. He denies any dizziness, chest pain, abdominal pain, n/v, weakness, or numbness. In ER patient was hypoxic and improved only with BiPAP. Per chart review patient had cardiac arrest on 11/2020 for 17 minutes. He has a significant cardiac history consisting of stemi, fem-pop bypass surgery, PVD, CABG x4, AFib post ablation 2017, V-tach. He was started on therapy with steroids, anticoagulation, and Remdesivir. He failed to improve and had increasing oxygen requirements. He was eventually intubated. Due to failure to improve patient was made DNR and eventually expired."
	"1351475-1"	"1351475-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient was hospitalized and died within 60 days of receiving a COVID vaccine series"
	"1351556-1"	"1351556-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient was hospitalized multiple times and died within 60 days of receiving a COVID vaccine series"
	"1354321-1"	"1354321-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Hospice patient death within 60 days of receiving a COVID vaccine"
	"1354336-1"	"1354336-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient was hospitalized multiple times and died at home within 60 days of receiving a COVID vaccine"
	"1354848-1"	"1354848-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient was hospitalized and died within 60 days of receiving a COVID vaccine series"
	"1355032-1"	"1355032-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient was hospitalized and died within 60 days of receiving a COVID vaccine"
	"1364886-1"	"1364886-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death after fall and hospitalization."
	"1364886-1"	"1364886-1"	"FALL"	"10016173"	"65-79 years"	"65-79"	"Death after fall and hospitalization."
	"1371446-1"	"1371446-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Admitted for syncopal episode on 5/14/21, found to have lung lesion with necrotizing granulomatous inflammation, deceased 5/20/21"
	"1371446-1"	"1371446-1"	"LUNG DISORDER"	"10025082"	"65-79 years"	"65-79"	"Admitted for syncopal episode on 5/14/21, found to have lung lesion with necrotizing granulomatous inflammation, deceased 5/20/21"
	"1371446-1"	"1371446-1"	"PNEUMONITIS"	"10035742"	"65-79 years"	"65-79"	"Admitted for syncopal episode on 5/14/21, found to have lung lesion with necrotizing granulomatous inflammation, deceased 5/20/21"
	"1371446-1"	"1371446-1"	"PULMONARY GRANULOMA"	"10037391"	"65-79 years"	"65-79"	"Admitted for syncopal episode on 5/14/21, found to have lung lesion with necrotizing granulomatous inflammation, deceased 5/20/21"
	"1371446-1"	"1371446-1"	"SYNCOPE"	"10042772"	"65-79 years"	"65-79"	"Admitted for syncopal episode on 5/14/21, found to have lung lesion with necrotizing granulomatous inflammation, deceased 5/20/21"
	"1371933-1"	"1371933-1"	"MYOCARDIAL INFARCTION"	"10028596"	"65-79 years"	"65-79"	"On May 19th at approximately 10-1030 pm. My father suffered a heart attack with no warning and died instantly. He was fine all day long, fine since the second shot. We don?t believe the vaccine was the cause but maybe it jumpstarted something.  We wanted to alert someone for knowledge or research. We did not have an autopsy."
	"1371933-1"	"1371933-1"	"SUDDEN CARDIAC DEATH"	"10049418"	"65-79 years"	"65-79"	"On May 19th at approximately 10-1030 pm. My father suffered a heart attack with no warning and died instantly. He was fine all day long, fine since the second shot. We don?t believe the vaccine was the cause but maybe it jumpstarted something.  We wanted to alert someone for knowledge or research. We did not have an autopsy."
	"1377765-1"	"1377765-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"My mother was the patient in question She had a Moderna Covid Vaccine in Feb/March of 2021.  She then had 2 doses of Rituxan on April 28th of 2021.  After her second dose of the medication, she tested positive for covid 3 days later. She was hospitalized on May 8th and was not able to recover. She passed away on May 20th.  The Drs at the Hospital in told me the rituxan essentially wiped the vaccine from her body.  The reason I'm reporting this is to warn others in her position about the possible side effects. My mom had a very false sense of security."
	"1377765-1"	"1377765-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"My mother was the patient in question She had a Moderna Covid Vaccine in Feb/March of 2021.  She then had 2 doses of Rituxan on April 28th of 2021.  After her second dose of the medication, she tested positive for covid 3 days later. She was hospitalized on May 8th and was not able to recover. She passed away on May 20th.  The Drs at the Hospital in told me the rituxan essentially wiped the vaccine from her body.  The reason I'm reporting this is to warn others in her position about the possible side effects. My mom had a very false sense of security."
	"1377765-1"	"1377765-1"	"DIALYSIS"	"10061105"	"65-79 years"	"65-79"	"My mother was the patient in question She had a Moderna Covid Vaccine in Feb/March of 2021.  She then had 2 doses of Rituxan on April 28th of 2021.  After her second dose of the medication, she tested positive for covid 3 days later. She was hospitalized on May 8th and was not able to recover. She passed away on May 20th.  The Drs at the Hospital in told me the rituxan essentially wiped the vaccine from her body.  The reason I'm reporting this is to warn others in her position about the possible side effects. My mom had a very false sense of security."
	"1377765-1"	"1377765-1"	"DRUG INTERACTION"	"10013710"	"65-79 years"	"65-79"	"My mother was the patient in question She had a Moderna Covid Vaccine in Feb/March of 2021.  She then had 2 doses of Rituxan on April 28th of 2021.  After her second dose of the medication, she tested positive for covid 3 days later. She was hospitalized on May 8th and was not able to recover. She passed away on May 20th.  The Drs at the Hospital in told me the rituxan essentially wiped the vaccine from her body.  The reason I'm reporting this is to warn others in her position about the possible side effects. My mom had a very false sense of security."
	"1377765-1"	"1377765-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"My mother was the patient in question She had a Moderna Covid Vaccine in Feb/March of 2021.  She then had 2 doses of Rituxan on April 28th of 2021.  After her second dose of the medication, she tested positive for covid 3 days later. She was hospitalized on May 8th and was not able to recover. She passed away on May 20th.  The Drs at the Hospital in told me the rituxan essentially wiped the vaccine from her body.  The reason I'm reporting this is to warn others in her position about the possible side effects. My mom had a very false sense of security."
	"1377765-1"	"1377765-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"My mother was the patient in question She had a Moderna Covid Vaccine in Feb/March of 2021.  She then had 2 doses of Rituxan on April 28th of 2021.  After her second dose of the medication, she tested positive for covid 3 days later. She was hospitalized on May 8th and was not able to recover. She passed away on May 20th.  The Drs at the Hospital in told me the rituxan essentially wiped the vaccine from her body.  The reason I'm reporting this is to warn others in her position about the possible side effects. My mom had a very false sense of security."
	"1382493-1"	"1382493-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"headaches, nausea, tired , all over run down, not able to eat"
	"1382493-1"	"1382493-1"	"FEEDING DISORDER"	"10061148"	"65-79 years"	"65-79"	"headaches, nausea, tired , all over run down, not able to eat"
	"1382493-1"	"1382493-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	"headaches, nausea, tired , all over run down, not able to eat"
	"1382493-1"	"1382493-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"headaches, nausea, tired , all over run down, not able to eat"
	"1382638-1"	"1382638-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient received his second dose of the Moderna vaccine on 5/21/21. On the morning of 5/22/21, patient started having issues with mobility, heavy sweats, body aches, and headache, although he had no fever and maintained his sense of smell and taste. Patient was later hospitalized and tested positive for COVID on Thursday, May 27, 2021. Patient passed away on Friday, May 28, 2021."
	"1382638-1"	"1382638-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received his second dose of the Moderna vaccine on 5/21/21. On the morning of 5/22/21, patient started having issues with mobility, heavy sweats, body aches, and headache, although he had no fever and maintained his sense of smell and taste. Patient was later hospitalized and tested positive for COVID on Thursday, May 27, 2021. Patient passed away on Friday, May 28, 2021."
	"1382638-1"	"1382638-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	"Patient received his second dose of the Moderna vaccine on 5/21/21. On the morning of 5/22/21, patient started having issues with mobility, heavy sweats, body aches, and headache, although he had no fever and maintained his sense of smell and taste. Patient was later hospitalized and tested positive for COVID on Thursday, May 27, 2021. Patient passed away on Friday, May 28, 2021."
	"1382638-1"	"1382638-1"	"HYPERHIDROSIS"	"10020642"	"65-79 years"	"65-79"	"Patient received his second dose of the Moderna vaccine on 5/21/21. On the morning of 5/22/21, patient started having issues with mobility, heavy sweats, body aches, and headache, although he had no fever and maintained his sense of smell and taste. Patient was later hospitalized and tested positive for COVID on Thursday, May 27, 2021. Patient passed away on Friday, May 28, 2021."
	"1382638-1"	"1382638-1"	"MOVEMENT DISORDER"	"10028035"	"65-79 years"	"65-79"	"Patient received his second dose of the Moderna vaccine on 5/21/21. On the morning of 5/22/21, patient started having issues with mobility, heavy sweats, body aches, and headache, although he had no fever and maintained his sense of smell and taste. Patient was later hospitalized and tested positive for COVID on Thursday, May 27, 2021. Patient passed away on Friday, May 28, 2021."
	"1382638-1"	"1382638-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	"Patient received his second dose of the Moderna vaccine on 5/21/21. On the morning of 5/22/21, patient started having issues with mobility, heavy sweats, body aches, and headache, although he had no fever and maintained his sense of smell and taste. Patient was later hospitalized and tested positive for COVID on Thursday, May 27, 2021. Patient passed away on Friday, May 28, 2021."
	"1382638-1"	"1382638-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient received his second dose of the Moderna vaccine on 5/21/21. On the morning of 5/22/21, patient started having issues with mobility, heavy sweats, body aches, and headache, although he had no fever and maintained his sense of smell and taste. Patient was later hospitalized and tested positive for COVID on Thursday, May 27, 2021. Patient passed away on Friday, May 28, 2021."
	"1386215-1"	"1386215-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death within 60 days of vaccination"
	"1395978-1"	"1395978-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"Approx 16 days following vaccine patient's Sp02 saturation dropped to 70-80% despite being on 6liters O2"
	"1396353-1"	"1396353-1"	"ABDOMINAL DISTENSION"	"10000060"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"ABDOMINAL PAIN"	"10000081"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"ARTERIOSCLEROSIS"	"10003210"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"AUTOPSY"	"10050117"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"BRONCHIAL IRRITATION"	"10006438"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"CORONARY ARTERY DISEASE"	"10011078"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"EMPHYSEMA"	"10014561"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"ENTERITIS"	"10014866"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"EOSINOPHILIA"	"10014950"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"HYPERTENSION"	"10020772"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"MYOCARDIAL FIBROSIS"	"10028594"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"MYOCARDITIS"	"10028606"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"OEDEMA"	"10030095"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"RESPIRATORY VIRAL PANEL"	"10075165"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"TOXICOLOGIC TEST NORMAL"	"10061383"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"TRYPTASE"	"10063240"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1396353-1"	"1396353-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful."
	"1399352-1"	"1399352-1"	"CATARACT OPERATION"	"10063797"	"65-79 years"	"65-79"	"Patient had cataract surgery in mid May, developed shortness of breath after, was seen in ER and admitted.  Found to have stage 4 small cell lung cancer (not a smoker to my knowledge).  Stayed in hospital until June 3rd when he was transferred home to medical center for end of life care.  Died June 7th."
	"1399352-1"	"1399352-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient had cataract surgery in mid May, developed shortness of breath after, was seen in ER and admitted.  Found to have stage 4 small cell lung cancer (not a smoker to my knowledge).  Stayed in hospital until June 3rd when he was transferred home to medical center for end of life care.  Died June 7th."
	"1399352-1"	"1399352-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient had cataract surgery in mid May, developed shortness of breath after, was seen in ER and admitted.  Found to have stage 4 small cell lung cancer (not a smoker to my knowledge).  Stayed in hospital until June 3rd when he was transferred home to medical center for end of life care.  Died June 7th."
	"1399352-1"	"1399352-1"	"SMALL CELL LUNG CANCER"	"10041067"	"65-79 years"	"65-79"	"Patient had cataract surgery in mid May, developed shortness of breath after, was seen in ER and admitted.  Found to have stage 4 small cell lung cancer (not a smoker to my knowledge).  Stayed in hospital until June 3rd when he was transferred home to medical center for end of life care.  Died June 7th."
	"1399868-1"	"1399868-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Family reported that the patient died 6 hours after being vaccinated."
	"1410369-1"	"1410369-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"Patient received 2nd dose of the COVID-19 vaccine on 2/10/21 and was considered fully vaccinated two weeks later on 2/24/21. On 6/10/21 patient was hospitalized with a possible upper GI bleed. Overnight the patient began to have increased oxygen needs and crackles on auscultation. She was transferred to the ICU, had an abnormal chest x-ray, and tested PCR positive for COVID-19. The patient had acute kidney failure and respiratory failure with a DNR and DNI. She expired on 6/11/21."
	"1410369-1"	"1410369-1"	"AUSCULTATION"	"10076270"	"65-79 years"	"65-79"	"Patient received 2nd dose of the COVID-19 vaccine on 2/10/21 and was considered fully vaccinated two weeks later on 2/24/21. On 6/10/21 patient was hospitalized with a possible upper GI bleed. Overnight the patient began to have increased oxygen needs and crackles on auscultation. She was transferred to the ICU, had an abnormal chest x-ray, and tested PCR positive for COVID-19. The patient had acute kidney failure and respiratory failure with a DNR and DNI. She expired on 6/11/21."
	"1410369-1"	"1410369-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"Patient received 2nd dose of the COVID-19 vaccine on 2/10/21 and was considered fully vaccinated two weeks later on 2/24/21. On 6/10/21 patient was hospitalized with a possible upper GI bleed. Overnight the patient began to have increased oxygen needs and crackles on auscultation. She was transferred to the ICU, had an abnormal chest x-ray, and tested PCR positive for COVID-19. The patient had acute kidney failure and respiratory failure with a DNR and DNI. She expired on 6/11/21."
	"1410369-1"	"1410369-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient received 2nd dose of the COVID-19 vaccine on 2/10/21 and was considered fully vaccinated two weeks later on 2/24/21. On 6/10/21 patient was hospitalized with a possible upper GI bleed. Overnight the patient began to have increased oxygen needs and crackles on auscultation. She was transferred to the ICU, had an abnormal chest x-ray, and tested PCR positive for COVID-19. The patient had acute kidney failure and respiratory failure with a DNR and DNI. She expired on 6/11/21."
	"1410369-1"	"1410369-1"	"CREPITATIONS"	"10011376"	"65-79 years"	"65-79"	"Patient received 2nd dose of the COVID-19 vaccine on 2/10/21 and was considered fully vaccinated two weeks later on 2/24/21. On 6/10/21 patient was hospitalized with a possible upper GI bleed. Overnight the patient began to have increased oxygen needs and crackles on auscultation. She was transferred to the ICU, had an abnormal chest x-ray, and tested PCR positive for COVID-19. The patient had acute kidney failure and respiratory failure with a DNR and DNI. She expired on 6/11/21."
	"1410369-1"	"1410369-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received 2nd dose of the COVID-19 vaccine on 2/10/21 and was considered fully vaccinated two weeks later on 2/24/21. On 6/10/21 patient was hospitalized with a possible upper GI bleed. Overnight the patient began to have increased oxygen needs and crackles on auscultation. She was transferred to the ICU, had an abnormal chest x-ray, and tested PCR positive for COVID-19. The patient had acute kidney failure and respiratory failure with a DNR and DNI. She expired on 6/11/21."
	"1410369-1"	"1410369-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Patient received 2nd dose of the COVID-19 vaccine on 2/10/21 and was considered fully vaccinated two weeks later on 2/24/21. On 6/10/21 patient was hospitalized with a possible upper GI bleed. Overnight the patient began to have increased oxygen needs and crackles on auscultation. She was transferred to the ICU, had an abnormal chest x-ray, and tested PCR positive for COVID-19. The patient had acute kidney failure and respiratory failure with a DNR and DNI. She expired on 6/11/21."
	"1410369-1"	"1410369-1"	"RESPIRATORY FAILURE"	"10038695"	"65-79 years"	"65-79"	"Patient received 2nd dose of the COVID-19 vaccine on 2/10/21 and was considered fully vaccinated two weeks later on 2/24/21. On 6/10/21 patient was hospitalized with a possible upper GI bleed. Overnight the patient began to have increased oxygen needs and crackles on auscultation. She was transferred to the ICU, had an abnormal chest x-ray, and tested PCR positive for COVID-19. The patient had acute kidney failure and respiratory failure with a DNR and DNI. She expired on 6/11/21."
	"1410369-1"	"1410369-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient received 2nd dose of the COVID-19 vaccine on 2/10/21 and was considered fully vaccinated two weeks later on 2/24/21. On 6/10/21 patient was hospitalized with a possible upper GI bleed. Overnight the patient began to have increased oxygen needs and crackles on auscultation. She was transferred to the ICU, had an abnormal chest x-ray, and tested PCR positive for COVID-19. The patient had acute kidney failure and respiratory failure with a DNR and DNI. She expired on 6/11/21."
	"1410369-1"	"1410369-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"Patient received 2nd dose of the COVID-19 vaccine on 2/10/21 and was considered fully vaccinated two weeks later on 2/24/21. On 6/10/21 patient was hospitalized with a possible upper GI bleed. Overnight the patient began to have increased oxygen needs and crackles on auscultation. She was transferred to the ICU, had an abnormal chest x-ray, and tested PCR positive for COVID-19. The patient had acute kidney failure and respiratory failure with a DNR and DNI. She expired on 6/11/21."
	"1410894-1"	"1410894-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient was hospitalized due to COVID-19 from May 19, 2021 to May 22, 2021. Patient was then placed on hospice on 6/5/2021 and expired on 6/7/2021."
	"1410894-1"	"1410894-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient was hospitalized due to COVID-19 from May 19, 2021 to May 22, 2021. Patient was then placed on hospice on 6/5/2021 and expired on 6/7/2021."
	"1410894-1"	"1410894-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient was hospitalized due to COVID-19 from May 19, 2021 to May 22, 2021. Patient was then placed on hospice on 6/5/2021 and expired on 6/7/2021."
	"1413849-1"	"1413849-1"	"ARTERIOSCLEROSIS"	"10003210"	"65-79 years"	"65-79"	"COPD  She was a resident at the Senior Living facility.  My mother received the vaccine on Tuesday, May 18, 2021 at approximately 11:00 a.m.  She was left by herself and called around at 11:32 to say she got the vaccine and she was having a hard time breathing.  Around 1:40, the nursing home called to let me know CPR was being performed.  My sister rushed to the site and  she was pronounced dead around 2:10. p.m."
	"1413849-1"	"1413849-1"	"CHRONIC OBSTRUCTIVE PULMONARY DISEASE"	"10009033"	"65-79 years"	"65-79"	"COPD  She was a resident at the Senior Living facility.  My mother received the vaccine on Tuesday, May 18, 2021 at approximately 11:00 a.m.  She was left by herself and called around at 11:32 to say she got the vaccine and she was having a hard time breathing.  Around 1:40, the nursing home called to let me know CPR was being performed.  My sister rushed to the site and  she was pronounced dead around 2:10. p.m."
	"1413849-1"	"1413849-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"COPD  She was a resident at the Senior Living facility.  My mother received the vaccine on Tuesday, May 18, 2021 at approximately 11:00 a.m.  She was left by herself and called around at 11:32 to say she got the vaccine and she was having a hard time breathing.  Around 1:40, the nursing home called to let me know CPR was being performed.  My sister rushed to the site and  she was pronounced dead around 2:10. p.m."
	"1413849-1"	"1413849-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"COPD  She was a resident at the Senior Living facility.  My mother received the vaccine on Tuesday, May 18, 2021 at approximately 11:00 a.m.  She was left by herself and called around at 11:32 to say she got the vaccine and she was having a hard time breathing.  Around 1:40, the nursing home called to let me know CPR was being performed.  My sister rushed to the site and  she was pronounced dead around 2:10. p.m."
	"1413849-1"	"1413849-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"COPD  She was a resident at the Senior Living facility.  My mother received the vaccine on Tuesday, May 18, 2021 at approximately 11:00 a.m.  She was left by herself and called around at 11:32 to say she got the vaccine and she was having a hard time breathing.  Around 1:40, the nursing home called to let me know CPR was being performed.  My sister rushed to the site and  she was pronounced dead around 2:10. p.m."
	"1414207-1"	"1414207-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  During admission received dexamethasone, convalescent plasma, remdesivir.  Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21."
	"1414207-1"	"1414207-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  During admission received dexamethasone, convalescent plasma, remdesivir.  Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21."
	"1414207-1"	"1414207-1"	"BRONCHIECTASIS"	"10006445"	"65-79 years"	"65-79"	"Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  During admission received dexamethasone, convalescent plasma, remdesivir.  Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21."
	"1414207-1"	"1414207-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  During admission received dexamethasone, convalescent plasma, remdesivir.  Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21."
	"1414207-1"	"1414207-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  During admission received dexamethasone, convalescent plasma, remdesivir.  Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21."
	"1414207-1"	"1414207-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  During admission received dexamethasone, convalescent plasma, remdesivir.  Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21."
	"1414207-1"	"1414207-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  During admission received dexamethasone, convalescent plasma, remdesivir.  Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21."
	"1414207-1"	"1414207-1"	"CULTURE POSITIVE"	"10061449"	"65-79 years"	"65-79"	"Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  During admission received dexamethasone, convalescent plasma, remdesivir.  Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21."
	"1414207-1"	"1414207-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  During admission received dexamethasone, convalescent plasma, remdesivir.  Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21."
	"1414207-1"	"1414207-1"	"DYSPNOEA EXERTIONAL"	"10013971"	"65-79 years"	"65-79"	"Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  During admission received dexamethasone, convalescent plasma, remdesivir.  Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21."
	"1414207-1"	"1414207-1"	"HYPERCAPNIA"	"10020591"	"65-79 years"	"65-79"	"Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  During admission received dexamethasone, convalescent plasma, remdesivir.  Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21."
	"1414207-1"	"1414207-1"	"LUNG INFILTRATION"	"10025102"	"65-79 years"	"65-79"	"Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  During admission received dexamethasone, convalescent plasma, remdesivir.  Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21."
	"1414207-1"	"1414207-1"	"LUNG OPACITY"	"10081792"	"65-79 years"	"65-79"	"Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  During admission received dexamethasone, convalescent plasma, remdesivir.  Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21."
	"1414207-1"	"1414207-1"	"PNEUMONIA PSEUDOMONAL"	"10035731"	"65-79 years"	"65-79"	"Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  During admission received dexamethasone, convalescent plasma, remdesivir.  Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21."
	"1414207-1"	"1414207-1"	"PULMONARY OEDEMA"	"10037423"	"65-79 years"	"65-79"	"Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  During admission received dexamethasone, convalescent plasma, remdesivir.  Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21."
	"1414207-1"	"1414207-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  During admission received dexamethasone, convalescent plasma, remdesivir.  Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21."
	"1416990-1"	"1416990-1"	"ABDOMINAL PAIN UPPER"	"10000087"	"65-79 years"	"65-79"	"Patient's wife stated Husband 2021/03/12 muscle pain in legs, fever 2021/03/14 (100.4), chills (Treated temp down 99.8), stomach/muscle pains. Contact with Dr. 2021/03/17 (Fever 100.7) phoned. No treatments for nausea, headache, muscle pains.  Hospital visit ER with confusion/hallucinations. Temp 100.4 BP 136/110, *8:30am 2021/03/19. Home incident of falling, EMS called (vitals normal) admitted in Hospital. Transferred to another Hospital (Covid Neg.), stated bad infections. Death 2021/03/21"
	"1416990-1"	"1416990-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"Patient's wife stated Husband 2021/03/12 muscle pain in legs, fever 2021/03/14 (100.4), chills (Treated temp down 99.8), stomach/muscle pains. Contact with Dr. 2021/03/17 (Fever 100.7) phoned. No treatments for nausea, headache, muscle pains.  Hospital visit ER with confusion/hallucinations. Temp 100.4 BP 136/110, *8:30am 2021/03/19. Home incident of falling, EMS called (vitals normal) admitted in Hospital. Transferred to another Hospital (Covid Neg.), stated bad infections. Death 2021/03/21"
	"1416990-1"	"1416990-1"	"CONFUSIONAL STATE"	"10010305"	"65-79 years"	"65-79"	"Patient's wife stated Husband 2021/03/12 muscle pain in legs, fever 2021/03/14 (100.4), chills (Treated temp down 99.8), stomach/muscle pains. Contact with Dr. 2021/03/17 (Fever 100.7) phoned. No treatments for nausea, headache, muscle pains.  Hospital visit ER with confusion/hallucinations. Temp 100.4 BP 136/110, *8:30am 2021/03/19. Home incident of falling, EMS called (vitals normal) admitted in Hospital. Transferred to another Hospital (Covid Neg.), stated bad infections. Death 2021/03/21"
	"1416990-1"	"1416990-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient's wife stated Husband 2021/03/12 muscle pain in legs, fever 2021/03/14 (100.4), chills (Treated temp down 99.8), stomach/muscle pains. Contact with Dr. 2021/03/17 (Fever 100.7) phoned. No treatments for nausea, headache, muscle pains.  Hospital visit ER with confusion/hallucinations. Temp 100.4 BP 136/110, *8:30am 2021/03/19. Home incident of falling, EMS called (vitals normal) admitted in Hospital. Transferred to another Hospital (Covid Neg.), stated bad infections. Death 2021/03/21"
	"1416990-1"	"1416990-1"	"FALL"	"10016173"	"65-79 years"	"65-79"	"Patient's wife stated Husband 2021/03/12 muscle pain in legs, fever 2021/03/14 (100.4), chills (Treated temp down 99.8), stomach/muscle pains. Contact with Dr. 2021/03/17 (Fever 100.7) phoned. No treatments for nausea, headache, muscle pains.  Hospital visit ER with confusion/hallucinations. Temp 100.4 BP 136/110, *8:30am 2021/03/19. Home incident of falling, EMS called (vitals normal) admitted in Hospital. Transferred to another Hospital (Covid Neg.), stated bad infections. Death 2021/03/21"
	"1416990-1"	"1416990-1"	"HALLUCINATION"	"10019063"	"65-79 years"	"65-79"	"Patient's wife stated Husband 2021/03/12 muscle pain in legs, fever 2021/03/14 (100.4), chills (Treated temp down 99.8), stomach/muscle pains. Contact with Dr. 2021/03/17 (Fever 100.7) phoned. No treatments for nausea, headache, muscle pains.  Hospital visit ER with confusion/hallucinations. Temp 100.4 BP 136/110, *8:30am 2021/03/19. Home incident of falling, EMS called (vitals normal) admitted in Hospital. Transferred to another Hospital (Covid Neg.), stated bad infections. Death 2021/03/21"
	"1416990-1"	"1416990-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	"Patient's wife stated Husband 2021/03/12 muscle pain in legs, fever 2021/03/14 (100.4), chills (Treated temp down 99.8), stomach/muscle pains. Contact with Dr. 2021/03/17 (Fever 100.7) phoned. No treatments for nausea, headache, muscle pains.  Hospital visit ER with confusion/hallucinations. Temp 100.4 BP 136/110, *8:30am 2021/03/19. Home incident of falling, EMS called (vitals normal) admitted in Hospital. Transferred to another Hospital (Covid Neg.), stated bad infections. Death 2021/03/21"
	"1416990-1"	"1416990-1"	"INFECTION"	"10021789"	"65-79 years"	"65-79"	"Patient's wife stated Husband 2021/03/12 muscle pain in legs, fever 2021/03/14 (100.4), chills (Treated temp down 99.8), stomach/muscle pains. Contact with Dr. 2021/03/17 (Fever 100.7) phoned. No treatments for nausea, headache, muscle pains.  Hospital visit ER with confusion/hallucinations. Temp 100.4 BP 136/110, *8:30am 2021/03/19. Home incident of falling, EMS called (vitals normal) admitted in Hospital. Transferred to another Hospital (Covid Neg.), stated bad infections. Death 2021/03/21"
	"1416990-1"	"1416990-1"	"MYALGIA"	"10028411"	"65-79 years"	"65-79"	"Patient's wife stated Husband 2021/03/12 muscle pain in legs, fever 2021/03/14 (100.4), chills (Treated temp down 99.8), stomach/muscle pains. Contact with Dr. 2021/03/17 (Fever 100.7) phoned. No treatments for nausea, headache, muscle pains.  Hospital visit ER with confusion/hallucinations. Temp 100.4 BP 136/110, *8:30am 2021/03/19. Home incident of falling, EMS called (vitals normal) admitted in Hospital. Transferred to another Hospital (Covid Neg.), stated bad infections. Death 2021/03/21"
	"1416990-1"	"1416990-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"Patient's wife stated Husband 2021/03/12 muscle pain in legs, fever 2021/03/14 (100.4), chills (Treated temp down 99.8), stomach/muscle pains. Contact with Dr. 2021/03/17 (Fever 100.7) phoned. No treatments for nausea, headache, muscle pains.  Hospital visit ER with confusion/hallucinations. Temp 100.4 BP 136/110, *8:30am 2021/03/19. Home incident of falling, EMS called (vitals normal) admitted in Hospital. Transferred to another Hospital (Covid Neg.), stated bad infections. Death 2021/03/21"
	"1416990-1"	"1416990-1"	"PAIN IN EXTREMITY"	"10033425"	"65-79 years"	"65-79"	"Patient's wife stated Husband 2021/03/12 muscle pain in legs, fever 2021/03/14 (100.4), chills (Treated temp down 99.8), stomach/muscle pains. Contact with Dr. 2021/03/17 (Fever 100.7) phoned. No treatments for nausea, headache, muscle pains.  Hospital visit ER with confusion/hallucinations. Temp 100.4 BP 136/110, *8:30am 2021/03/19. Home incident of falling, EMS called (vitals normal) admitted in Hospital. Transferred to another Hospital (Covid Neg.), stated bad infections. Death 2021/03/21"
	"1416990-1"	"1416990-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"Patient's wife stated Husband 2021/03/12 muscle pain in legs, fever 2021/03/14 (100.4), chills (Treated temp down 99.8), stomach/muscle pains. Contact with Dr. 2021/03/17 (Fever 100.7) phoned. No treatments for nausea, headache, muscle pains.  Hospital visit ER with confusion/hallucinations. Temp 100.4 BP 136/110, *8:30am 2021/03/19. Home incident of falling, EMS called (vitals normal) admitted in Hospital. Transferred to another Hospital (Covid Neg.), stated bad infections. Death 2021/03/21"
	"1416990-1"	"1416990-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	"Patient's wife stated Husband 2021/03/12 muscle pain in legs, fever 2021/03/14 (100.4), chills (Treated temp down 99.8), stomach/muscle pains. Contact with Dr. 2021/03/17 (Fever 100.7) phoned. No treatments for nausea, headache, muscle pains.  Hospital visit ER with confusion/hallucinations. Temp 100.4 BP 136/110, *8:30am 2021/03/19. Home incident of falling, EMS called (vitals normal) admitted in Hospital. Transferred to another Hospital (Covid Neg.), stated bad infections. Death 2021/03/21"
	"1418084-1"	"1418084-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Developed s/s of COVID on 4/27/2021, hospitalized, then transferred to another HCF was inpatient ICU 5/8-6/21  expired 6/21/21"
	"1418084-1"	"1418084-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Developed s/s of COVID on 4/27/2021, hospitalized, then transferred to another HCF was inpatient ICU 5/8-6/21  expired 6/21/21"
	"1418084-1"	"1418084-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Developed s/s of COVID on 4/27/2021, hospitalized, then transferred to another HCF was inpatient ICU 5/8-6/21  expired 6/21/21"
	"1418084-1"	"1418084-1"	"SARS-COV-2 RNA INCREASED"	"10085495"	"65-79 years"	"65-79"	"Developed s/s of COVID on 4/27/2021, hospitalized, then transferred to another HCF was inpatient ICU 5/8-6/21  expired 6/21/21"
	"1421767-1"	"1421767-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient died"
	"1423625-1"	"1423625-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Two hours after receiving her 2nd dose of the Pfizer Covid Vaccine, patient had a Stroke (large brain bleed).  She never recovered and passed away May 18th, 2021"
	"1423625-1"	"1423625-1"	"HAEMORRHAGIC STROKE"	"10019016"	"65-79 years"	"65-79"	"Two hours after receiving her 2nd dose of the Pfizer Covid Vaccine, patient had a Stroke (large brain bleed).  She never recovered and passed away May 18th, 2021"
	"1427845-1"	"1427845-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Hospice patient was hospitalized and died within 60 days of receiving a COVID vaccine series"
	"1427880-1"	"1427880-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient was hospitalized and died within 60 days of receiving a COVID vaccine series"
	"1430652-1"	"1430652-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient noted with decline in condition starting from his first vaccine and expired shortly after 2nd vaccine."
	"1430652-1"	"1430652-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Patient noted with decline in condition starting from his first vaccine and expired shortly after 2nd vaccine."
	"1430991-1"	"1430991-1"	"FALL"	"10016173"	"65-79 years"	"65-79"	"Patient was a 77 year old, resident, past medical history of dementia, hypertension, schizophrenia, hyperlipidemia, Parkinson's disease. Patient presented to the ED with altered mental status and a potential seizure. In the morning of 3/24, patient reportedly had an episode of seizure that lasted 30 seconds, generalized tonic/clonic. It is unknown if she fell  or hit her head. Per manager, patient is following Neurology, recent work up for possible syncopal month ago. Patient received her 2nd dose of Moderna Vaccine recently on 3/19. At baseline patient is independent, ambulates by her self. Patient has been ill after receiving a COVID vaccine last week. Patient has progressive weakness of the bilateral lower extremities and progressive difficulties with talking , had had multiple falls."
	"1430991-1"	"1430991-1"	"GENERALISED TONIC-CLONIC SEIZURE"	"10018100"	"65-79 years"	"65-79"	"Patient was a 77 year old, resident, past medical history of dementia, hypertension, schizophrenia, hyperlipidemia, Parkinson's disease. Patient presented to the ED with altered mental status and a potential seizure. In the morning of 3/24, patient reportedly had an episode of seizure that lasted 30 seconds, generalized tonic/clonic. It is unknown if she fell  or hit her head. Per manager, patient is following Neurology, recent work up for possible syncopal month ago. Patient received her 2nd dose of Moderna Vaccine recently on 3/19. At baseline patient is independent, ambulates by her self. Patient has been ill after receiving a COVID vaccine last week. Patient has progressive weakness of the bilateral lower extremities and progressive difficulties with talking , had had multiple falls."
	"1430991-1"	"1430991-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Patient was a 77 year old, resident, past medical history of dementia, hypertension, schizophrenia, hyperlipidemia, Parkinson's disease. Patient presented to the ED with altered mental status and a potential seizure. In the morning of 3/24, patient reportedly had an episode of seizure that lasted 30 seconds, generalized tonic/clonic. It is unknown if she fell  or hit her head. Per manager, patient is following Neurology, recent work up for possible syncopal month ago. Patient received her 2nd dose of Moderna Vaccine recently on 3/19. At baseline patient is independent, ambulates by her self. Patient has been ill after receiving a COVID vaccine last week. Patient has progressive weakness of the bilateral lower extremities and progressive difficulties with talking , had had multiple falls."
	"1430991-1"	"1430991-1"	"MENTAL STATUS CHANGES"	"10048294"	"65-79 years"	"65-79"	"Patient was a 77 year old, resident, past medical history of dementia, hypertension, schizophrenia, hyperlipidemia, Parkinson's disease. Patient presented to the ED with altered mental status and a potential seizure. In the morning of 3/24, patient reportedly had an episode of seizure that lasted 30 seconds, generalized tonic/clonic. It is unknown if she fell  or hit her head. Per manager, patient is following Neurology, recent work up for possible syncopal month ago. Patient received her 2nd dose of Moderna Vaccine recently on 3/19. At baseline patient is independent, ambulates by her self. Patient has been ill after receiving a COVID vaccine last week. Patient has progressive weakness of the bilateral lower extremities and progressive difficulties with talking , had had multiple falls."
	"1430991-1"	"1430991-1"	"MUSCULAR WEAKNESS"	"10028372"	"65-79 years"	"65-79"	"Patient was a 77 year old, resident, past medical history of dementia, hypertension, schizophrenia, hyperlipidemia, Parkinson's disease. Patient presented to the ED with altered mental status and a potential seizure. In the morning of 3/24, patient reportedly had an episode of seizure that lasted 30 seconds, generalized tonic/clonic. It is unknown if she fell  or hit her head. Per manager, patient is following Neurology, recent work up for possible syncopal month ago. Patient received her 2nd dose of Moderna Vaccine recently on 3/19. At baseline patient is independent, ambulates by her self. Patient has been ill after receiving a COVID vaccine last week. Patient has progressive weakness of the bilateral lower extremities and progressive difficulties with talking , had had multiple falls."
	"1430991-1"	"1430991-1"	"SPEECH DISORDER"	"10041466"	"65-79 years"	"65-79"	"Patient was a 77 year old, resident, past medical history of dementia, hypertension, schizophrenia, hyperlipidemia, Parkinson's disease. Patient presented to the ED with altered mental status and a potential seizure. In the morning of 3/24, patient reportedly had an episode of seizure that lasted 30 seconds, generalized tonic/clonic. It is unknown if she fell  or hit her head. Per manager, patient is following Neurology, recent work up for possible syncopal month ago. Patient received her 2nd dose of Moderna Vaccine recently on 3/19. At baseline patient is independent, ambulates by her self. Patient has been ill after receiving a COVID vaccine last week. Patient has progressive weakness of the bilateral lower extremities and progressive difficulties with talking , had had multiple falls."
	"1432862-1"	"1432862-1"	"METASTASES TO BONE"	"10027452"	"65-79 years"	"65-79"	"Small cell carcinoma; cancer of pancreas / metastasized; Metastases to lungs; Metastates to bone; Metastases to brain; Wheezing; This spontaneous case was reported by a consumer and describes the occurrence of SMALL CELL CARCINOMA (Small cell carcinoma), METASTASES TO PANCREAS (cancer of pancreas / metastasized), METASTASES TO LUNG (Metastases to lungs), METASTASES TO BONE (Metastates to bone), METASTASES TO CENTRAL NERVOUS SYSTEM (Metastases to brain) and WHEEZING (Wheezing) in a 70-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination.     No Medical History information was reported.   On 04-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 11-Mar-2021, the patient experienced WHEEZING (Wheezing) (seriousness criterion hospitalization). On an unknown date, the patient experienced SMALL CELL CARCINOMA (Small cell carcinoma) (seriousness criteria death, hospitalization and medically significant), METASTASES TO PANCREAS (cancer of pancreas / metastasized) (seriousness criteria death, hospitalization and medically significant), METASTASES TO LUNG (Metastases to lungs) (seriousness criteria death, hospitalization and medically significant), METASTASES TO BONE (Metastates to bone) (seriousness criteria death, hospitalization and medically significant) and METASTASES TO CENTRAL NERVOUS SYSTEM (Metastases to brain) (seriousness criteria death, hospitalization and medically significant). The patient was hospitalized from 25-Apr-2021 to 10-May-2021 due to METASTASES TO BONE, METASTASES TO CENTRAL NERVOUS SYSTEM, METASTASES TO LUNG, METASTASES TO PANCREAS, SMALL CELL CARCINOMA and WHEEZING. The patient died on 10-May-2021. The reported cause of death was Cancer of lung, Bone cancer, Metastases to brain, Pancreas cancer and Small cell carcinoma. It is unknown if an autopsy was performed. At the time of death, WHEEZING (Wheezing) outcome was unknown.        For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   Concomitant Product use was not provided.  LABORATORY / DIAGNOSTIC TEST: Ultrasound, computerized tomography (CAT) scan and numerous other tests; result was not provided.   Treatment information was not provided. Action taken with mRNA-1273 (Moderna COVID-19 Vaccine) in response to the event was not applicable.  Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: cancer of lung; bone cancer; metastases to brain; pancreas cancer; small cell carcinoma"
	"1432862-1"	"1432862-1"	"METASTASES TO CENTRAL NERVOUS SYSTEM"	"10059282"	"65-79 years"	"65-79"	"Small cell carcinoma; cancer of pancreas / metastasized; Metastases to lungs; Metastates to bone; Metastases to brain; Wheezing; This spontaneous case was reported by a consumer and describes the occurrence of SMALL CELL CARCINOMA (Small cell carcinoma), METASTASES TO PANCREAS (cancer of pancreas / metastasized), METASTASES TO LUNG (Metastases to lungs), METASTASES TO BONE (Metastates to bone), METASTASES TO CENTRAL NERVOUS SYSTEM (Metastases to brain) and WHEEZING (Wheezing) in a 70-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination.     No Medical History information was reported.   On 04-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 11-Mar-2021, the patient experienced WHEEZING (Wheezing) (seriousness criterion hospitalization). On an unknown date, the patient experienced SMALL CELL CARCINOMA (Small cell carcinoma) (seriousness criteria death, hospitalization and medically significant), METASTASES TO PANCREAS (cancer of pancreas / metastasized) (seriousness criteria death, hospitalization and medically significant), METASTASES TO LUNG (Metastases to lungs) (seriousness criteria death, hospitalization and medically significant), METASTASES TO BONE (Metastates to bone) (seriousness criteria death, hospitalization and medically significant) and METASTASES TO CENTRAL NERVOUS SYSTEM (Metastases to brain) (seriousness criteria death, hospitalization and medically significant). The patient was hospitalized from 25-Apr-2021 to 10-May-2021 due to METASTASES TO BONE, METASTASES TO CENTRAL NERVOUS SYSTEM, METASTASES TO LUNG, METASTASES TO PANCREAS, SMALL CELL CARCINOMA and WHEEZING. The patient died on 10-May-2021. The reported cause of death was Cancer of lung, Bone cancer, Metastases to brain, Pancreas cancer and Small cell carcinoma. It is unknown if an autopsy was performed. At the time of death, WHEEZING (Wheezing) outcome was unknown.        For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   Concomitant Product use was not provided.  LABORATORY / DIAGNOSTIC TEST: Ultrasound, computerized tomography (CAT) scan and numerous other tests; result was not provided.   Treatment information was not provided. Action taken with mRNA-1273 (Moderna COVID-19 Vaccine) in response to the event was not applicable.  Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: cancer of lung; bone cancer; metastases to brain; pancreas cancer; small cell carcinoma"
	"1432862-1"	"1432862-1"	"METASTASES TO LUNG"	"10027458"	"65-79 years"	"65-79"	"Small cell carcinoma; cancer of pancreas / metastasized; Metastases to lungs; Metastates to bone; Metastases to brain; Wheezing; This spontaneous case was reported by a consumer and describes the occurrence of SMALL CELL CARCINOMA (Small cell carcinoma), METASTASES TO PANCREAS (cancer of pancreas / metastasized), METASTASES TO LUNG (Metastases to lungs), METASTASES TO BONE (Metastates to bone), METASTASES TO CENTRAL NERVOUS SYSTEM (Metastases to brain) and WHEEZING (Wheezing) in a 70-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination.     No Medical History information was reported.   On 04-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 11-Mar-2021, the patient experienced WHEEZING (Wheezing) (seriousness criterion hospitalization). On an unknown date, the patient experienced SMALL CELL CARCINOMA (Small cell carcinoma) (seriousness criteria death, hospitalization and medically significant), METASTASES TO PANCREAS (cancer of pancreas / metastasized) (seriousness criteria death, hospitalization and medically significant), METASTASES TO LUNG (Metastases to lungs) (seriousness criteria death, hospitalization and medically significant), METASTASES TO BONE (Metastates to bone) (seriousness criteria death, hospitalization and medically significant) and METASTASES TO CENTRAL NERVOUS SYSTEM (Metastases to brain) (seriousness criteria death, hospitalization and medically significant). The patient was hospitalized from 25-Apr-2021 to 10-May-2021 due to METASTASES TO BONE, METASTASES TO CENTRAL NERVOUS SYSTEM, METASTASES TO LUNG, METASTASES TO PANCREAS, SMALL CELL CARCINOMA and WHEEZING. The patient died on 10-May-2021. The reported cause of death was Cancer of lung, Bone cancer, Metastases to brain, Pancreas cancer and Small cell carcinoma. It is unknown if an autopsy was performed. At the time of death, WHEEZING (Wheezing) outcome was unknown.        For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   Concomitant Product use was not provided.  LABORATORY / DIAGNOSTIC TEST: Ultrasound, computerized tomography (CAT) scan and numerous other tests; result was not provided.   Treatment information was not provided. Action taken with mRNA-1273 (Moderna COVID-19 Vaccine) in response to the event was not applicable.  Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: cancer of lung; bone cancer; metastases to brain; pancreas cancer; small cell carcinoma"
	"1432862-1"	"1432862-1"	"METASTASES TO PANCREAS"	"10049721"	"65-79 years"	"65-79"	"Small cell carcinoma; cancer of pancreas / metastasized; Metastases to lungs; Metastates to bone; Metastases to brain; Wheezing; This spontaneous case was reported by a consumer and describes the occurrence of SMALL CELL CARCINOMA (Small cell carcinoma), METASTASES TO PANCREAS (cancer of pancreas / metastasized), METASTASES TO LUNG (Metastases to lungs), METASTASES TO BONE (Metastates to bone), METASTASES TO CENTRAL NERVOUS SYSTEM (Metastases to brain) and WHEEZING (Wheezing) in a 70-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination.     No Medical History information was reported.   On 04-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 11-Mar-2021, the patient experienced WHEEZING (Wheezing) (seriousness criterion hospitalization). On an unknown date, the patient experienced SMALL CELL CARCINOMA (Small cell carcinoma) (seriousness criteria death, hospitalization and medically significant), METASTASES TO PANCREAS (cancer of pancreas / metastasized) (seriousness criteria death, hospitalization and medically significant), METASTASES TO LUNG (Metastases to lungs) (seriousness criteria death, hospitalization and medically significant), METASTASES TO BONE (Metastates to bone) (seriousness criteria death, hospitalization and medically significant) and METASTASES TO CENTRAL NERVOUS SYSTEM (Metastases to brain) (seriousness criteria death, hospitalization and medically significant). The patient was hospitalized from 25-Apr-2021 to 10-May-2021 due to METASTASES TO BONE, METASTASES TO CENTRAL NERVOUS SYSTEM, METASTASES TO LUNG, METASTASES TO PANCREAS, SMALL CELL CARCINOMA and WHEEZING. The patient died on 10-May-2021. The reported cause of death was Cancer of lung, Bone cancer, Metastases to brain, Pancreas cancer and Small cell carcinoma. It is unknown if an autopsy was performed. At the time of death, WHEEZING (Wheezing) outcome was unknown.        For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   Concomitant Product use was not provided.  LABORATORY / DIAGNOSTIC TEST: Ultrasound, computerized tomography (CAT) scan and numerous other tests; result was not provided.   Treatment information was not provided. Action taken with mRNA-1273 (Moderna COVID-19 Vaccine) in response to the event was not applicable.  Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: cancer of lung; bone cancer; metastases to brain; pancreas cancer; small cell carcinoma"
	"1432862-1"	"1432862-1"	"SMALL CELL CARCINOMA"	"10041056"	"65-79 years"	"65-79"	"Small cell carcinoma; cancer of pancreas / metastasized; Metastases to lungs; Metastates to bone; Metastases to brain; Wheezing; This spontaneous case was reported by a consumer and describes the occurrence of SMALL CELL CARCINOMA (Small cell carcinoma), METASTASES TO PANCREAS (cancer of pancreas / metastasized), METASTASES TO LUNG (Metastases to lungs), METASTASES TO BONE (Metastates to bone), METASTASES TO CENTRAL NERVOUS SYSTEM (Metastases to brain) and WHEEZING (Wheezing) in a 70-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination.     No Medical History information was reported.   On 04-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 11-Mar-2021, the patient experienced WHEEZING (Wheezing) (seriousness criterion hospitalization). On an unknown date, the patient experienced SMALL CELL CARCINOMA (Small cell carcinoma) (seriousness criteria death, hospitalization and medically significant), METASTASES TO PANCREAS (cancer of pancreas / metastasized) (seriousness criteria death, hospitalization and medically significant), METASTASES TO LUNG (Metastases to lungs) (seriousness criteria death, hospitalization and medically significant), METASTASES TO BONE (Metastates to bone) (seriousness criteria death, hospitalization and medically significant) and METASTASES TO CENTRAL NERVOUS SYSTEM (Metastases to brain) (seriousness criteria death, hospitalization and medically significant). The patient was hospitalized from 25-Apr-2021 to 10-May-2021 due to METASTASES TO BONE, METASTASES TO CENTRAL NERVOUS SYSTEM, METASTASES TO LUNG, METASTASES TO PANCREAS, SMALL CELL CARCINOMA and WHEEZING. The patient died on 10-May-2021. The reported cause of death was Cancer of lung, Bone cancer, Metastases to brain, Pancreas cancer and Small cell carcinoma. It is unknown if an autopsy was performed. At the time of death, WHEEZING (Wheezing) outcome was unknown.        For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   Concomitant Product use was not provided.  LABORATORY / DIAGNOSTIC TEST: Ultrasound, computerized tomography (CAT) scan and numerous other tests; result was not provided.   Treatment information was not provided. Action taken with mRNA-1273 (Moderna COVID-19 Vaccine) in response to the event was not applicable.  Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: cancer of lung; bone cancer; metastases to brain; pancreas cancer; small cell carcinoma"
	"1432862-1"	"1432862-1"	"WHEEZING"	"10047924"	"65-79 years"	"65-79"	"Small cell carcinoma; cancer of pancreas / metastasized; Metastases to lungs; Metastates to bone; Metastases to brain; Wheezing; This spontaneous case was reported by a consumer and describes the occurrence of SMALL CELL CARCINOMA (Small cell carcinoma), METASTASES TO PANCREAS (cancer of pancreas / metastasized), METASTASES TO LUNG (Metastases to lungs), METASTASES TO BONE (Metastates to bone), METASTASES TO CENTRAL NERVOUS SYSTEM (Metastases to brain) and WHEEZING (Wheezing) in a 70-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination.     No Medical History information was reported.   On 04-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 01-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 11-Mar-2021, the patient experienced WHEEZING (Wheezing) (seriousness criterion hospitalization). On an unknown date, the patient experienced SMALL CELL CARCINOMA (Small cell carcinoma) (seriousness criteria death, hospitalization and medically significant), METASTASES TO PANCREAS (cancer of pancreas / metastasized) (seriousness criteria death, hospitalization and medically significant), METASTASES TO LUNG (Metastases to lungs) (seriousness criteria death, hospitalization and medically significant), METASTASES TO BONE (Metastates to bone) (seriousness criteria death, hospitalization and medically significant) and METASTASES TO CENTRAL NERVOUS SYSTEM (Metastases to brain) (seriousness criteria death, hospitalization and medically significant). The patient was hospitalized from 25-Apr-2021 to 10-May-2021 due to METASTASES TO BONE, METASTASES TO CENTRAL NERVOUS SYSTEM, METASTASES TO LUNG, METASTASES TO PANCREAS, SMALL CELL CARCINOMA and WHEEZING. The patient died on 10-May-2021. The reported cause of death was Cancer of lung, Bone cancer, Metastases to brain, Pancreas cancer and Small cell carcinoma. It is unknown if an autopsy was performed. At the time of death, WHEEZING (Wheezing) outcome was unknown.        For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   Concomitant Product use was not provided.  LABORATORY / DIAGNOSTIC TEST: Ultrasound, computerized tomography (CAT) scan and numerous other tests; result was not provided.   Treatment information was not provided. Action taken with mRNA-1273 (Moderna COVID-19 Vaccine) in response to the event was not applicable.  Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: cancer of lung; bone cancer; metastases to brain; pancreas cancer; small cell carcinoma"
	"1433463-1"	"1433463-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 02/17/2021."
	"1433491-1"	"1433491-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 03/12/2021"
	"1433561-1"	"1433561-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 03/07/2021"
	"1433683-1"	"1433683-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 04/18/2021"
	"1433714-1"	"1433714-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 04/28/2021"
	"1433778-1"	"1433778-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 05/01/2021"
	"1433815-1"	"1433815-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 04/18/2021."
	"1433851-1"	"1433851-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"patient passed away on 05/03/2021."
	"1433859-1"	"1433859-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient signed off of dialysis on 05/31/2021. Patient passed away on 06/07/2021"
	"1440865-1"	"1440865-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	""Family stated patient had been weaker since ""last covid shot"".   Patient death 5-5-2021 - 1 week after vaccination""
	"1440865-1"	"1440865-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	""Family stated patient had been weaker since ""last covid shot"".   Patient death 5-5-2021 - 1 week after vaccination""
	"1443294-1"	"1443294-1"	"ANTINUCLEAR ANTIBODY INCREASED"	"10064726"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"BLOOD TEST"	"10061726"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"CATHETERISATION CARDIAC"	"10007815"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"CEREBRAL INFARCTION"	"10008118"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"COMPUTERISED TOMOGRAM HEAD ABNORMAL"	"10072168"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"COMPUTERISED TOMOGRAM THORAX NORMAL"	"10057801"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"ECHOCARDIOGRAM NORMAL"	"10014115"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"EMBOLIC STROKE"	"10014498"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"ENCEPHALOPATHY"	"10014625"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"EXTUBATION"	"10015894"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"ISCHAEMIC HEPATITIS"	"10023025"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"RED BLOOD CELL SEDIMENTATION RATE INCREASED"	"10049187"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"REFUSAL OF TREATMENT BY RELATIVE"	"10056406"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"SEIZURE ANOXIC"	"10039907"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1443294-1"	"1443294-1"	"SWELLING"	"10042674"	"65-79 years"	"65-79"	"Unusual swelling.  Pr referred by PCP to rheumatology and nephrology for elevated ESR and ANA w/ concern for poss vasculitis or nephritis..  While work-up in process,  pt experienced cardiopulmonary arrest.  Hospitalized and ventilator supported.  Remained encephalopathic, presumed anoxic, w/ seizure disorder and shock liver that precluded proceeding w/ planned coronary/cardiac catheterization.  CT chest showed no pulm emb, CT brain showed multiple punctate infarcts suggestive of embolic etiology.  Neurology felt infarcts could not explain his encephalopathy.  Echocardiogram neg.  Family declined trach and PEG and pt was compassionately weaned to comfort from ventilator support, extubated and transitioned to hospice care.  Pt passed 6/22/21.  Autopsy declined."
	"1444577-1"	"1444577-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"My father became ill after the 2nd does and did not recover. His legs began to hurt. He found it hard to walk.  He didn?t want to go to the doctor from fear of COVID. But his legs began to swell and he couldn?t walk, so he went to ER on 4/18/2021 and released on 04/20/2021. He then went to his PCP on 04/28/2021. He went to see a cardiologist who said his heart was good on 04/30/2021. He passed away on 05/06/2021 in his sleep. Please help."
	"1444577-1"	"1444577-1"	"GAIT DISTURBANCE"	"10017577"	"65-79 years"	"65-79"	"My father became ill after the 2nd does and did not recover. His legs began to hurt. He found it hard to walk.  He didn?t want to go to the doctor from fear of COVID. But his legs began to swell and he couldn?t walk, so he went to ER on 4/18/2021 and released on 04/20/2021. He then went to his PCP on 04/28/2021. He went to see a cardiologist who said his heart was good on 04/30/2021. He passed away on 05/06/2021 in his sleep. Please help."
	"1444577-1"	"1444577-1"	"GAIT INABILITY"	"10017581"	"65-79 years"	"65-79"	"My father became ill after the 2nd does and did not recover. His legs began to hurt. He found it hard to walk.  He didn?t want to go to the doctor from fear of COVID. But his legs began to swell and he couldn?t walk, so he went to ER on 4/18/2021 and released on 04/20/2021. He then went to his PCP on 04/28/2021. He went to see a cardiologist who said his heart was good on 04/30/2021. He passed away on 05/06/2021 in his sleep. Please help."
	"1444577-1"	"1444577-1"	"ILLNESS"	"10080284"	"65-79 years"	"65-79"	"My father became ill after the 2nd does and did not recover. His legs began to hurt. He found it hard to walk.  He didn?t want to go to the doctor from fear of COVID. But his legs began to swell and he couldn?t walk, so he went to ER on 4/18/2021 and released on 04/20/2021. He then went to his PCP on 04/28/2021. He went to see a cardiologist who said his heart was good on 04/30/2021. He passed away on 05/06/2021 in his sleep. Please help."
	"1444577-1"	"1444577-1"	"PAIN IN EXTREMITY"	"10033425"	"65-79 years"	"65-79"	"My father became ill after the 2nd does and did not recover. His legs began to hurt. He found it hard to walk.  He didn?t want to go to the doctor from fear of COVID. But his legs began to swell and he couldn?t walk, so he went to ER on 4/18/2021 and released on 04/20/2021. He then went to his PCP on 04/28/2021. He went to see a cardiologist who said his heart was good on 04/30/2021. He passed away on 05/06/2021 in his sleep. Please help."
	"1444577-1"	"1444577-1"	"PERIPHERAL SWELLING"	"10048959"	"65-79 years"	"65-79"	"My father became ill after the 2nd does and did not recover. His legs began to hurt. He found it hard to walk.  He didn?t want to go to the doctor from fear of COVID. But his legs began to swell and he couldn?t walk, so he went to ER on 4/18/2021 and released on 04/20/2021. He then went to his PCP on 04/28/2021. He went to see a cardiologist who said his heart was good on 04/30/2021. He passed away on 05/06/2021 in his sleep. Please help."
	"1450294-1"	"1450294-1"	"ACUTE RESPIRATORY DISTRESS SYNDROME"	"10001052"	"65-79 years"	"65-79"	"Found dead.  Evidence of diffuse alveolar pulmonary damage (ARDS, DAD)."
	"1450294-1"	"1450294-1"	"AUTOPSY"	"10050117"	"65-79 years"	"65-79"	"Found dead.  Evidence of diffuse alveolar pulmonary damage (ARDS, DAD)."
	"1450294-1"	"1450294-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Found dead.  Evidence of diffuse alveolar pulmonary damage (ARDS, DAD)."
	"1450294-1"	"1450294-1"	"DIFFUSE ALVEOLAR DAMAGE"	"10060902"	"65-79 years"	"65-79"	"Found dead.  Evidence of diffuse alveolar pulmonary damage (ARDS, DAD)."
	"1457253-1"	"1457253-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 02/18/2021."
	"1466773-1"	"1466773-1"	"BRAIN DEATH"	"10049054"	"65-79 years"	"65-79"	"Convulsions, loss of brain function, then death."
	"1466773-1"	"1466773-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Convulsions, loss of brain function, then death."
	"1466773-1"	"1466773-1"	"SEIZURE"	"10039906"	"65-79 years"	"65-79"	"Convulsions, loss of brain function, then death."
	"1474305-1"	"1474305-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt died 05/27/2021- not a covid related death  Vaccine #2 Moderna 03/05/2021 Lot # 032M20A"
	"1487263-1"	"1487263-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 06/03/2021"
	"1487270-1"	"1487270-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 07/09/2021"
	"1487290-1"	"1487290-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 06/25/2021"
	"1487451-1"	"1487451-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 06/10/2021."
	"1491868-1"	"1491868-1"	"APHASIA"	"10002948"	"65-79 years"	"65-79"	"alphasia , ..March 4   March 18....MRI,  CT SCAN,  EKG.... brain tumors  March 23....Crainiotomy Brain Cancer"
	"1491868-1"	"1491868-1"	"BRAIN NEOPLASM"	"10061019"	"65-79 years"	"65-79"	"alphasia , ..March 4   March 18....MRI,  CT SCAN,  EKG.... brain tumors  March 23....Crainiotomy Brain Cancer"
	"1491868-1"	"1491868-1"	"COMPUTERISED TOMOGRAM"	"10010234"	"65-79 years"	"65-79"	"alphasia , ..March 4   March 18....MRI,  CT SCAN,  EKG.... brain tumors  March 23....Crainiotomy Brain Cancer"
	"1491868-1"	"1491868-1"	"CRANIOTOMY"	"10011322"	"65-79 years"	"65-79"	"alphasia , ..March 4   March 18....MRI,  CT SCAN,  EKG.... brain tumors  March 23....Crainiotomy Brain Cancer"
	"1491868-1"	"1491868-1"	"ELECTROCARDIOGRAM"	"10014362"	"65-79 years"	"65-79"	"alphasia , ..March 4   March 18....MRI,  CT SCAN,  EKG.... brain tumors  March 23....Crainiotomy Brain Cancer"
	"1491868-1"	"1491868-1"	"MAGNETIC RESONANCE IMAGING"	"10078223"	"65-79 years"	"65-79"	"alphasia , ..March 4   March 18....MRI,  CT SCAN,  EKG.... brain tumors  March 23....Crainiotomy Brain Cancer"
	"1491868-1"	"1491868-1"	"NEOPLASM MALIGNANT"	"10028997"	"65-79 years"	"65-79"	"alphasia , ..March 4   March 18....MRI,  CT SCAN,  EKG.... brain tumors  March 23....Crainiotomy Brain Cancer"
	"1502205-1"	"1502205-1"	"AORTIC VALVE REPLACEMENT"	"10002916"	"65-79 years"	"65-79"	"Death. Last known May 19, 2021. Found May 25, 2021"
	"1502205-1"	"1502205-1"	"AORTIC VALVE STENOSIS"	"10002918"	"65-79 years"	"65-79"	"Death. Last known May 19, 2021. Found May 25, 2021"
	"1502205-1"	"1502205-1"	"CARDIAC FAILURE"	"10007554"	"65-79 years"	"65-79"	"Death. Last known May 19, 2021. Found May 25, 2021"
	"1502205-1"	"1502205-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death. Last known May 19, 2021. Found May 25, 2021"
	"1502205-1"	"1502205-1"	"EMPHYSEMA"	"10014561"	"65-79 years"	"65-79"	"Death. Last known May 19, 2021. Found May 25, 2021"
	"1505244-1"	"1505244-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death 7-23-21"
	"1505244-1"	"1505244-1"	"HEPATIC ENCEPHALOPATHY"	"10019660"	"65-79 years"	"65-79"	"Death 7-23-21"
	"1505244-1"	"1505244-1"	"LIVER DISORDER"	"10024670"	"65-79 years"	"65-79"	"Death 7-23-21"
	"1505518-1"	"1505518-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient was fully vaccinated in February, admitted to acute care hospital, positive for COVID19 in July. Patient diagnosed with COVID pneumonia, completed treatment, was considered recovered from COVID. Patient while still in acute care expired on 7/26/2021"
	"1505518-1"	"1505518-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Patient was fully vaccinated in February, admitted to acute care hospital, positive for COVID19 in July. Patient diagnosed with COVID pneumonia, completed treatment, was considered recovered from COVID. Patient while still in acute care expired on 7/26/2021"
	"1505518-1"	"1505518-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient was fully vaccinated in February, admitted to acute care hospital, positive for COVID19 in July. Patient diagnosed with COVID pneumonia, completed treatment, was considered recovered from COVID. Patient while still in acute care expired on 7/26/2021"
	"1505518-1"	"1505518-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient was fully vaccinated in February, admitted to acute care hospital, positive for COVID19 in July. Patient diagnosed with COVID pneumonia, completed treatment, was considered recovered from COVID. Patient while still in acute care expired on 7/26/2021"
	"1509613-1"	"1509613-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Dose #1 Moderna 01/20/2021 Lot # 041L20A Pt died  while in the hospital"
	"1509983-1"	"1509983-1"	"ASTHMA"	"10003553"	"65-79 years"	"65-79"	"The patient received the Janssen vaccine on 5-29-21 and had previously well controlled asthma. The patient presented to ED on 6-1-21, 6-13-21, 6-28-21, and 7-19-21  with acute asthma exacerbation. On 7-21-21 the patient was admitted into the ED and later ICU with cardiac arrest related to asthma acerbation and pronounced deceased on 7-25-21.  Symptoms: - Wheezing -Shortness of breath - Onset following the day after vaccine administration  Treatments: - Albuterol/ipratropium nebulizers - Prednisone -Albuterol inhaler"
	"1509983-1"	"1509983-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"The patient received the Janssen vaccine on 5-29-21 and had previously well controlled asthma. The patient presented to ED on 6-1-21, 6-13-21, 6-28-21, and 7-19-21  with acute asthma exacerbation. On 7-21-21 the patient was admitted into the ED and later ICU with cardiac arrest related to asthma acerbation and pronounced deceased on 7-25-21.  Symptoms: - Wheezing -Shortness of breath - Onset following the day after vaccine administration  Treatments: - Albuterol/ipratropium nebulizers - Prednisone -Albuterol inhaler"
	"1509983-1"	"1509983-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"The patient received the Janssen vaccine on 5-29-21 and had previously well controlled asthma. The patient presented to ED on 6-1-21, 6-13-21, 6-28-21, and 7-19-21  with acute asthma exacerbation. On 7-21-21 the patient was admitted into the ED and later ICU with cardiac arrest related to asthma acerbation and pronounced deceased on 7-25-21.  Symptoms: - Wheezing -Shortness of breath - Onset following the day after vaccine administration  Treatments: - Albuterol/ipratropium nebulizers - Prednisone -Albuterol inhaler"
	"1509983-1"	"1509983-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"The patient received the Janssen vaccine on 5-29-21 and had previously well controlled asthma. The patient presented to ED on 6-1-21, 6-13-21, 6-28-21, and 7-19-21  with acute asthma exacerbation. On 7-21-21 the patient was admitted into the ED and later ICU with cardiac arrest related to asthma acerbation and pronounced deceased on 7-25-21.  Symptoms: - Wheezing -Shortness of breath - Onset following the day after vaccine administration  Treatments: - Albuterol/ipratropium nebulizers - Prednisone -Albuterol inhaler"
	"1509983-1"	"1509983-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"The patient received the Janssen vaccine on 5-29-21 and had previously well controlled asthma. The patient presented to ED on 6-1-21, 6-13-21, 6-28-21, and 7-19-21  with acute asthma exacerbation. On 7-21-21 the patient was admitted into the ED and later ICU with cardiac arrest related to asthma acerbation and pronounced deceased on 7-25-21.  Symptoms: - Wheezing -Shortness of breath - Onset following the day after vaccine administration  Treatments: - Albuterol/ipratropium nebulizers - Prednisone -Albuterol inhaler"
	"1509983-1"	"1509983-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"The patient received the Janssen vaccine on 5-29-21 and had previously well controlled asthma. The patient presented to ED on 6-1-21, 6-13-21, 6-28-21, and 7-19-21  with acute asthma exacerbation. On 7-21-21 the patient was admitted into the ED and later ICU with cardiac arrest related to asthma acerbation and pronounced deceased on 7-25-21.  Symptoms: - Wheezing -Shortness of breath - Onset following the day after vaccine administration  Treatments: - Albuterol/ipratropium nebulizers - Prednisone -Albuterol inhaler"
	"1509983-1"	"1509983-1"	"WHEEZING"	"10047924"	"65-79 years"	"65-79"	"The patient received the Janssen vaccine on 5-29-21 and had previously well controlled asthma. The patient presented to ED on 6-1-21, 6-13-21, 6-28-21, and 7-19-21  with acute asthma exacerbation. On 7-21-21 the patient was admitted into the ED and later ICU with cardiac arrest related to asthma acerbation and pronounced deceased on 7-25-21.  Symptoms: - Wheezing -Shortness of breath - Onset following the day after vaccine administration  Treatments: - Albuterol/ipratropium nebulizers - Prednisone -Albuterol inhaler"
	"1512969-1"	"1512969-1"	"CEREBRAL HAEMORRHAGE"	"10008111"	"65-79 years"	"65-79"	"After the vaccine the pt said she felt like she had the flu. She was tired and sore and achy. And a week later she went to bed and woke her husband up to help her to go the the bathroom, she collapsed on the way and the husband called 911 and was taken to the hospital and the doctor said she had a massive brain bleed, she was put on life support, she passed away five minutes after being taken off of life support."
	"1512969-1"	"1512969-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"After the vaccine the pt said she felt like she had the flu. She was tired and sore and achy. And a week later she went to bed and woke her husband up to help her to go the the bathroom, she collapsed on the way and the husband called 911 and was taken to the hospital and the doctor said she had a massive brain bleed, she was put on life support, she passed away five minutes after being taken off of life support."
	"1512969-1"	"1512969-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"After the vaccine the pt said she felt like she had the flu. She was tired and sore and achy. And a week later she went to bed and woke her husband up to help her to go the the bathroom, she collapsed on the way and the husband called 911 and was taken to the hospital and the doctor said she had a massive brain bleed, she was put on life support, she passed away five minutes after being taken off of life support."
	"1512969-1"	"1512969-1"	"INFLUENZA LIKE ILLNESS"	"10022004"	"65-79 years"	"65-79"	"After the vaccine the pt said she felt like she had the flu. She was tired and sore and achy. And a week later she went to bed and woke her husband up to help her to go the the bathroom, she collapsed on the way and the husband called 911 and was taken to the hospital and the doctor said she had a massive brain bleed, she was put on life support, she passed away five minutes after being taken off of life support."
	"1512969-1"	"1512969-1"	"LIFE SUPPORT"	"10024447"	"65-79 years"	"65-79"	"After the vaccine the pt said she felt like she had the flu. She was tired and sore and achy. And a week later she went to bed and woke her husband up to help her to go the the bathroom, she collapsed on the way and the husband called 911 and was taken to the hospital and the doctor said she had a massive brain bleed, she was put on life support, she passed away five minutes after being taken off of life support."
	"1512969-1"	"1512969-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	"After the vaccine the pt said she felt like she had the flu. She was tired and sore and achy. And a week later she went to bed and woke her husband up to help her to go the the bathroom, she collapsed on the way and the husband called 911 and was taken to the hospital and the doctor said she had a massive brain bleed, she was put on life support, she passed away five minutes after being taken off of life support."
	"1512969-1"	"1512969-1"	"SYNCOPE"	"10042772"	"65-79 years"	"65-79"	"After the vaccine the pt said she felt like she had the flu. She was tired and sore and achy. And a week later she went to bed and woke her husband up to help her to go the the bathroom, she collapsed on the way and the husband called 911 and was taken to the hospital and the doctor said she had a massive brain bleed, she was put on life support, she passed away five minutes after being taken off of life support."
	"1512969-1"	"1512969-1"	"WITHDRAWAL OF LIFE SUPPORT"	"10067595"	"65-79 years"	"65-79"	"After the vaccine the pt said she felt like she had the flu. She was tired and sore and achy. And a week later she went to bed and woke her husband up to help her to go the the bathroom, she collapsed on the way and the husband called 911 and was taken to the hospital and the doctor said she had a massive brain bleed, she was put on life support, she passed away five minutes after being taken off of life support."
	"1519902-1"	"1519902-1"	"AGITATION"	"10001497"	"65-79 years"	"65-79"	"Patient presented to ED for evaluation of headache, body aches, agitation.  Increased O2 needs once admitted, requiring high flow O2.  Greater than 14 days post J&J vaccination.  Patient passed away 8/2/2021"
	"1519902-1"	"1519902-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient presented to ED for evaluation of headache, body aches, agitation.  Increased O2 needs once admitted, requiring high flow O2.  Greater than 14 days post J&J vaccination.  Patient passed away 8/2/2021"
	"1519902-1"	"1519902-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient presented to ED for evaluation of headache, body aches, agitation.  Increased O2 needs once admitted, requiring high flow O2.  Greater than 14 days post J&J vaccination.  Patient passed away 8/2/2021"
	"1519902-1"	"1519902-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	"Patient presented to ED for evaluation of headache, body aches, agitation.  Increased O2 needs once admitted, requiring high flow O2.  Greater than 14 days post J&J vaccination.  Patient passed away 8/2/2021"
	"1519902-1"	"1519902-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"Patient presented to ED for evaluation of headache, body aches, agitation.  Increased O2 needs once admitted, requiring high flow O2.  Greater than 14 days post J&J vaccination.  Patient passed away 8/2/2021"
	"1519902-1"	"1519902-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	"Patient presented to ED for evaluation of headache, body aches, agitation.  Increased O2 needs once admitted, requiring high flow O2.  Greater than 14 days post J&J vaccination.  Patient passed away 8/2/2021"
	"1519902-1"	"1519902-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient presented to ED for evaluation of headache, body aches, agitation.  Increased O2 needs once admitted, requiring high flow O2.  Greater than 14 days post J&J vaccination.  Patient passed away 8/2/2021"
	"1526026-1"	"1526026-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pulmonary Embolism 7/20 presented to ED with right sided pain which he had for about 2 weeks. Denies any hx of trauma. Did admit to moving furniture but did not recall an injury.  D/C'd with chest wall pain and given Ultram 50mg 1 tab q 4hrs qty= 7.  on 7/26 he presented to ED with symptoms of PE and was dx'd with acute PE He was declared deceased on 7/29/21"
	"1526026-1"	"1526026-1"	"MUSCULOSKELETAL CHEST PAIN"	"10050819"	"65-79 years"	"65-79"	"Pulmonary Embolism 7/20 presented to ED with right sided pain which he had for about 2 weeks. Denies any hx of trauma. Did admit to moving furniture but did not recall an injury.  D/C'd with chest wall pain and given Ultram 50mg 1 tab q 4hrs qty= 7.  on 7/26 he presented to ED with symptoms of PE and was dx'd with acute PE He was declared deceased on 7/29/21"
	"1526026-1"	"1526026-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	"Pulmonary Embolism 7/20 presented to ED with right sided pain which he had for about 2 weeks. Denies any hx of trauma. Did admit to moving furniture but did not recall an injury.  D/C'd with chest wall pain and given Ultram 50mg 1 tab q 4hrs qty= 7.  on 7/26 he presented to ED with symptoms of PE and was dx'd with acute PE He was declared deceased on 7/29/21"
	"1526026-1"	"1526026-1"	"PULMONARY EMBOLISM"	"10037377"	"65-79 years"	"65-79"	"Pulmonary Embolism 7/20 presented to ED with right sided pain which he had for about 2 weeks. Denies any hx of trauma. Did admit to moving furniture but did not recall an injury.  D/C'd with chest wall pain and given Ultram 50mg 1 tab q 4hrs qty= 7.  on 7/26 he presented to ED with symptoms of PE and was dx'd with acute PE He was declared deceased on 7/29/21"
	"1526049-1"	"1526049-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"My dad had a cardiac arrest one month after his second vaccine. He had complained of severe indigestion for 6-8 hours within 2 days of his second dose and  refused medical attention for it.  The day he passed he did not verbalize any complaints."
	"1526049-1"	"1526049-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"My dad had a cardiac arrest one month after his second vaccine. He had complained of severe indigestion for 6-8 hours within 2 days of his second dose and  refused medical attention for it.  The day he passed he did not verbalize any complaints."
	"1526049-1"	"1526049-1"	"DYSPEPSIA"	"10013946"	"65-79 years"	"65-79"	"My dad had a cardiac arrest one month after his second vaccine. He had complained of severe indigestion for 6-8 hours within 2 days of his second dose and  refused medical attention for it.  The day he passed he did not verbalize any complaints."
	"1526134-1"	"1526134-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Came to ER 7.15.2021  for leg wound"
	"1526134-1"	"1526134-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Came to ER 7.15.2021  for leg wound"
	"1526134-1"	"1526134-1"	"LIMB INJURY"	"10061225"	"65-79 years"	"65-79"	"Came to ER 7.15.2021  for leg wound"
	"1526134-1"	"1526134-1"	"MENTAL STATUS CHANGES"	"10048294"	"65-79 years"	"65-79"	"Came to ER 7.15.2021  for leg wound"
	"1526134-1"	"1526134-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Came to ER 7.15.2021  for leg wound"
	"1526341-1"	"1526341-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient expired 19 days after receiving her first shot of Moderna.  Patients family is convinced the shot killed her and wants it reported.  patient has a history of vasculitis. Primary provider believes the vaccine could have contributed to her death.  Patient was on the transplant list and was told it was a requirement to receive this shot."
	"1528939-1"	"1528939-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 06/03/2021"
	"1531545-1"	"1531545-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient was found dead in his home on 07/27/2021."
	"1532192-1"	"1532192-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Vomiting, Heat Attack & Death"
	"1532192-1"	"1532192-1"	"MYOCARDIAL INFARCTION"	"10028596"	"65-79 years"	"65-79"	"Vomiting, Heat Attack & Death"
	"1532192-1"	"1532192-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"Vomiting, Heat Attack & Death"
	"1535996-1"	"1535996-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Covid 19 Pfizer, Lot # EL3247 #2 obtained 02/08/2021.  Client died August 2, 2021."
	"1536241-1"	"1536241-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"COVID PNEUMONIA DEATH 8/6/2021"
	"1536241-1"	"1536241-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"COVID PNEUMONIA DEATH 8/6/2021"
	"1536241-1"	"1536241-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"COVID PNEUMONIA DEATH 8/6/2021"
	"1537187-1"	"1537187-1"	"AUTOPSY"	"10050117"	"65-79 years"	"65-79"	"Pt died on April 15, 2021 of cardiac arrest."
	"1537187-1"	"1537187-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Pt died on April 15, 2021 of cardiac arrest."
	"1537187-1"	"1537187-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt died on April 15, 2021 of cardiac arrest."
	"1540391-1"	"1540391-1"	"CELLULITIS"	"10007882"	"65-79 years"	"65-79"	"Patient presented to the ED and was subsequently hospitalized for cellulitis of foot within 6 weeks of receiving COVID vaccination. She died on 7/12/2021."
	"1540391-1"	"1540391-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient presented to the ED and was subsequently hospitalized for cellulitis of foot within 6 weeks of receiving COVID vaccination. She died on 7/12/2021."
	"1541629-1"	"1541629-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	""DEATH.  My wife was in excellent health with no heart issues when she awoke five weeks after her second Pfizer shot feeling ""like a load of bricks was on her chest"".  She was transported by ambulance to the Hospital Emergency Room around 11 am on March 16, 2021. She was monitored closely and after a couple of hours, the attending folks said they didn't think it was a heart issue per fine blood work and full time EKG hook up.  They were looking at GI possibilities and wanted to keep her overnight, do a couple more tests in the morning and then send her home.  She stayed in an ER bay because there were no regular beds available. We made plans for the next morning and I left her around 8 pm and drove home. Around 2:50 am on the 17th, I received a phone call that she had a massive coronary event.  The were able to bring her back one time momentarily, but then she passed away within a few minutes.    I'm submitting this report because of the general belief that older women have heart attacks all the time.  However, though she felt a heavy chest pressure, twelve plus hours in an ER bay couldn't find any issues.  She may have had some coronary inflammation that may have been exacerbated by the vaccine but I and we will never know.  Nevertheless, this was sudden and unexpected and five weeks after her second vaccine dose and it seemed appropriate to toss it in your data pile.  Thanks.""
	"1541629-1"	"1541629-1"	"CHEST DISCOMFORT"	"10008469"	"65-79 years"	"65-79"	""DEATH.  My wife was in excellent health with no heart issues when she awoke five weeks after her second Pfizer shot feeling ""like a load of bricks was on her chest"".  She was transported by ambulance to the Hospital Emergency Room around 11 am on March 16, 2021. She was monitored closely and after a couple of hours, the attending folks said they didn't think it was a heart issue per fine blood work and full time EKG hook up.  They were looking at GI possibilities and wanted to keep her overnight, do a couple more tests in the morning and then send her home.  She stayed in an ER bay because there were no regular beds available. We made plans for the next morning and I left her around 8 pm and drove home. Around 2:50 am on the 17th, I received a phone call that she had a massive coronary event.  The were able to bring her back one time momentarily, but then she passed away within a few minutes.    I'm submitting this report because of the general belief that older women have heart attacks all the time.  However, though she felt a heavy chest pressure, twelve plus hours in an ER bay couldn't find any issues.  She may have had some coronary inflammation that may have been exacerbated by the vaccine but I and we will never know.  Nevertheless, this was sudden and unexpected and five weeks after her second vaccine dose and it seemed appropriate to toss it in your data pile.  Thanks.""
	"1541629-1"	"1541629-1"	"ELECTROCARDIOGRAM NORMAL"	"10014373"	"65-79 years"	"65-79"	""DEATH.  My wife was in excellent health with no heart issues when she awoke five weeks after her second Pfizer shot feeling ""like a load of bricks was on her chest"".  She was transported by ambulance to the Hospital Emergency Room around 11 am on March 16, 2021. She was monitored closely and after a couple of hours, the attending folks said they didn't think it was a heart issue per fine blood work and full time EKG hook up.  They were looking at GI possibilities and wanted to keep her overnight, do a couple more tests in the morning and then send her home.  She stayed in an ER bay because there were no regular beds available. We made plans for the next morning and I left her around 8 pm and drove home. Around 2:50 am on the 17th, I received a phone call that she had a massive coronary event.  The were able to bring her back one time momentarily, but then she passed away within a few minutes.    I'm submitting this report because of the general belief that older women have heart attacks all the time.  However, though she felt a heavy chest pressure, twelve plus hours in an ER bay couldn't find any issues.  She may have had some coronary inflammation that may have been exacerbated by the vaccine but I and we will never know.  Nevertheless, this was sudden and unexpected and five weeks after her second vaccine dose and it seemed appropriate to toss it in your data pile.  Thanks.""
	"1541629-1"	"1541629-1"	"SUDDEN DEATH"	"10042434"	"65-79 years"	"65-79"	""DEATH.  My wife was in excellent health with no heart issues when she awoke five weeks after her second Pfizer shot feeling ""like a load of bricks was on her chest"".  She was transported by ambulance to the Hospital Emergency Room around 11 am on March 16, 2021. She was monitored closely and after a couple of hours, the attending folks said they didn't think it was a heart issue per fine blood work and full time EKG hook up.  They were looking at GI possibilities and wanted to keep her overnight, do a couple more tests in the morning and then send her home.  She stayed in an ER bay because there were no regular beds available. We made plans for the next morning and I left her around 8 pm and drove home. Around 2:50 am on the 17th, I received a phone call that she had a massive coronary event.  The were able to bring her back one time momentarily, but then she passed away within a few minutes.    I'm submitting this report because of the general belief that older women have heart attacks all the time.  However, though she felt a heavy chest pressure, twelve plus hours in an ER bay couldn't find any issues.  She may have had some coronary inflammation that may have been exacerbated by the vaccine but I and we will never know.  Nevertheless, this was sudden and unexpected and five weeks after her second vaccine dose and it seemed appropriate to toss it in your data pile.  Thanks.""
	"1545170-1"	"1545170-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Vaccine #1 Moderna 02/04/2021 lot # 029K20A  Pt died of cardiac arrest on 08/06/2021"
	"1545170-1"	"1545170-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Vaccine #1 Moderna 02/04/2021 lot # 029K20A  Pt died of cardiac arrest on 08/06/2021"
	"1545319-1"	"1545319-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Dose #1 03/07/2021 Moderna lot # 032M20A  Pt died of cardiac arrest 8/2/2021"
	"1545319-1"	"1545319-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Dose #1 03/07/2021 Moderna lot # 032M20A  Pt died of cardiac arrest 8/2/2021"
	"1549543-1"	"1549543-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Breakthrough Covid."
	"1549543-1"	"1549543-1"	"INFECTION"	"10021789"	"65-79 years"	"65-79"	"Breakthrough Covid."
	"1549543-1"	"1549543-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Breakthrough Covid."
	"1558329-1"	"1558329-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient was found dead in the yard of his residence.  He laid in the yard for a couple of days before he was discovered.  No further information was provided by the family.  His wife lives with him in the home; however, she is disabled and unable to provide any information."
	"1574423-1"	"1574423-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Client tested positive for COVID-19 via PCR on 7/26/2021 after being fully vaccinated. Pfizer vaccine dose #1 administered on 1/22/2021 lot#EL9262 and Pfizer vaccine dose #2 administered on 2/12/2021 lot# EN9581. Client died on 7/29/2021 cause of death as COVID-19 per Coroner's office."
	"1574423-1"	"1574423-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Client tested positive for COVID-19 via PCR on 7/26/2021 after being fully vaccinated. Pfizer vaccine dose #1 administered on 1/22/2021 lot#EL9262 and Pfizer vaccine dose #2 administered on 2/12/2021 lot# EN9581. Client died on 7/29/2021 cause of death as COVID-19 per Coroner's office."
	"1574423-1"	"1574423-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Client tested positive for COVID-19 via PCR on 7/26/2021 after being fully vaccinated. Pfizer vaccine dose #1 administered on 1/22/2021 lot#EL9262 and Pfizer vaccine dose #2 administered on 2/12/2021 lot# EN9581. Client died on 7/29/2021 cause of death as COVID-19 per Coroner's office."
	"1577895-1"	"1577895-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 05/11/2021."
	"1578038-1"	"1578038-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Sxs onset 7/17. Moderna-1/21 and 2/18. Admitted to hospital 7/18 to 8/09. Died on 08/09 due to COVID related death per Disease report. Never admitted to ICU. Was in Step Down unit when he passed away"
	"1578038-1"	"1578038-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Sxs onset 7/17. Moderna-1/21 and 2/18. Admitted to hospital 7/18 to 8/09. Died on 08/09 due to COVID related death per Disease report. Never admitted to ICU. Was in Step Down unit when he passed away"
	"1578038-1"	"1578038-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Sxs onset 7/17. Moderna-1/21 and 2/18. Admitted to hospital 7/18 to 8/09. Died on 08/09 due to COVID related death per Disease report. Never admitted to ICU. Was in Step Down unit when he passed away"
	"1586331-1"	"1586331-1"	"ABDOMINAL DISCOMFORT"	"10000059"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"ABDOMINAL DISTENSION"	"10000060"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"ABDOMINAL PAIN"	"10000081"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"ABNORMAL FAECES"	"10000133"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"COAGULOPATHY"	"10009802"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"COLECTOMY"	"10061778"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"COLITIS ISCHAEMIC"	"10009895"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"COMPUTERISED TOMOGRAM ABDOMEN ABNORMAL"	"10057798"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"DIVERTICULITIS"	"10013538"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"EXPLORATIVE LAPAROTOMY"	"10053361"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"IMAGING PROCEDURE"	"10068979"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"INTESTINAL ISCHAEMIA"	"10022680"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"LABORATORY TEST"	"10059938"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"LARGE INTESTINAL OBSTRUCTION"	"10062062"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"SEPSIS"	"10040047"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586331-1"	"1586331-1"	"VASOPRESSIVE THERAPY"	"10064148"	"65-79 years"	"65-79"	"Patient expired due to Large Bowel Obstruction.  (found to be COVID positive)    Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery   Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum:   The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain.  She states that her pain just started this morning and really worsened around noon.  Has been rapidly worsening since that time.  She also notes significant nausea and abdominal distention.   She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope.  She reports that for the last several months the caliber of her stools has been very small.   AAOx3.  Writhing in pain.   No focal Neuro-deficits Non-labored respirations.   Very distended, severely ttp throughout Moving all extremities   A/P: 75 year old female with large bowel obstruction -large bowel obstruction:  The patient's CT scan and history are consistent with a diagnosis of large bowel obstruction.  She has evidence of severe dilation of all proximal colon.  The etiology of her obstruction is unclear.  It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation.  Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation.  She will need emergent operative exploration.  I discussed this case with the Dr with the colorectal surgery service.  Following our discussion the decision is made that the general surgery service should take the patient to the operating room.  I discussed the plan for operative intervention with the patient as well as her daughter.  I will plan for an exploratory laparotomy with sigmoid colectomy.  Risks of the surgery are significant.  We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support.  The patient voices understanding of these and is eager to proceed with surgery. -COVID positive:  The patient has already had COVID and has since been vaccinated.  She is PCR positive for COVID today.  I will take respiratory precautions.  Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis.  Reverse with PCC at this time for emergent operative intervention. -hypoxia:  The patient is hypoxic and requiring supplemental oxygen at this time.  This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis:  The patient has evidence of sepsis with the source of ischemic colon.  Administer broad-spectrum antibiotics at this time.  Procedure the operating room for source control.  Continue with hemodynamic support."
	"1586812-1"	"1586812-1"	"ACUTE RESPIRATORY DISTRESS SYNDROME"	"10001052"	"65-79 years"	"65-79"	"Dose 1 Moderna 02/09/2021 no lot #  Patient died of pneumonia, ARDS on 8/18/2021-not a covid infection, not vaccine related"
	"1586812-1"	"1586812-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Dose 1 Moderna 02/09/2021 no lot #  Patient died of pneumonia, ARDS on 8/18/2021-not a covid infection, not vaccine related"
	"1586812-1"	"1586812-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Dose 1 Moderna 02/09/2021 no lot #  Patient died of pneumonia, ARDS on 8/18/2021-not a covid infection, not vaccine related"
	"1586812-1"	"1586812-1"	"PNEUMONIA"	"10035664"	"65-79 years"	"65-79"	"Dose 1 Moderna 02/09/2021 no lot #  Patient died of pneumonia, ARDS on 8/18/2021-not a covid infection, not vaccine related"
	"1587255-1"	"1587255-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 08/05/2021"
	"1591258-1"	"1591258-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 07/30/2021."
	"1591265-1"	"1591265-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 08/01/2021."
	"1602904-1"	"1602904-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Patient developed high D-dimer and blood clots immediately after vaccination.  Kidney failure followed shortly thereafter.  Went into hypertensive cardiac arrest approximately 3 weeks later.  All started with vaccination."
	"1602904-1"	"1602904-1"	"CARDIAC STRESS TEST"	"10061027"	"65-79 years"	"65-79"	"Patient developed high D-dimer and blood clots immediately after vaccination.  Kidney failure followed shortly thereafter.  Went into hypertensive cardiac arrest approximately 3 weeks later.  All started with vaccination."
	"1602904-1"	"1602904-1"	"COMPUTERISED TOMOGRAM"	"10010234"	"65-79 years"	"65-79"	"Patient developed high D-dimer and blood clots immediately after vaccination.  Kidney failure followed shortly thereafter.  Went into hypertensive cardiac arrest approximately 3 weeks later.  All started with vaccination."
	"1602904-1"	"1602904-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Patient developed high D-dimer and blood clots immediately after vaccination.  Kidney failure followed shortly thereafter.  Went into hypertensive cardiac arrest approximately 3 weeks later.  All started with vaccination."
	"1602904-1"	"1602904-1"	"ECHOCARDIOGRAM"	"10014113"	"65-79 years"	"65-79"	"Patient developed high D-dimer and blood clots immediately after vaccination.  Kidney failure followed shortly thereafter.  Went into hypertensive cardiac arrest approximately 3 weeks later.  All started with vaccination."
	"1602904-1"	"1602904-1"	"FIBRIN D DIMER INCREASED"	"10016581"	"65-79 years"	"65-79"	"Patient developed high D-dimer and blood clots immediately after vaccination.  Kidney failure followed shortly thereafter.  Went into hypertensive cardiac arrest approximately 3 weeks later.  All started with vaccination."
	"1602904-1"	"1602904-1"	"HYPERTENSION"	"10020772"	"65-79 years"	"65-79"	"Patient developed high D-dimer and blood clots immediately after vaccination.  Kidney failure followed shortly thereafter.  Went into hypertensive cardiac arrest approximately 3 weeks later.  All started with vaccination."
	"1602904-1"	"1602904-1"	"RENAL FAILURE"	"10038435"	"65-79 years"	"65-79"	"Patient developed high D-dimer and blood clots immediately after vaccination.  Kidney failure followed shortly thereafter.  Went into hypertensive cardiac arrest approximately 3 weeks later.  All started with vaccination."
	"1602904-1"	"1602904-1"	"THROMBOSIS"	"10043607"	"65-79 years"	"65-79"	"Patient developed high D-dimer and blood clots immediately after vaccination.  Kidney failure followed shortly thereafter.  Went into hypertensive cardiac arrest approximately 3 weeks later.  All started with vaccination."
	"1623625-1"	"1623625-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient deceased on 5/4/21 - learned of this on 8/23/21 and filed report.  Unknown cause of death."
	"1624286-1"	"1624286-1"	"PULMONARY THROMBOSIS"	"10037437"	"65-79 years"	"65-79"	"Blood clots in both lungs."
	"1628702-1"	"1628702-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	""Patient went into cardiac arrest on 08/21/2021. Patient seen by wife ""going down"" and CPR was started within minutes. CPR performed prior to arrival to emergency room and after, patient also intubated. Patient non-responsive on arrival to hospital.  Patient ultimately died.""
	"1628702-1"	"1628702-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	""Patient went into cardiac arrest on 08/21/2021. Patient seen by wife ""going down"" and CPR was started within minutes. CPR performed prior to arrival to emergency room and after, patient also intubated. Patient non-responsive on arrival to hospital.  Patient ultimately died.""
	"1628702-1"	"1628702-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	""Patient went into cardiac arrest on 08/21/2021. Patient seen by wife ""going down"" and CPR was started within minutes. CPR performed prior to arrival to emergency room and after, patient also intubated. Patient non-responsive on arrival to hospital.  Patient ultimately died.""
	"1628702-1"	"1628702-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	""Patient went into cardiac arrest on 08/21/2021. Patient seen by wife ""going down"" and CPR was started within minutes. CPR performed prior to arrival to emergency room and after, patient also intubated. Patient non-responsive on arrival to hospital.  Patient ultimately died.""
	"1628702-1"	"1628702-1"	"SYNCOPE"	"10042772"	"65-79 years"	"65-79"	""Patient went into cardiac arrest on 08/21/2021. Patient seen by wife ""going down"" and CPR was started within minutes. CPR performed prior to arrival to emergency room and after, patient also intubated. Patient non-responsive on arrival to hospital.  Patient ultimately died.""
	"1628702-1"	"1628702-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	""Patient went into cardiac arrest on 08/21/2021. Patient seen by wife ""going down"" and CPR was started within minutes. CPR performed prior to arrival to emergency room and after, patient also intubated. Patient non-responsive on arrival to hospital.  Patient ultimately died.""
	"1637396-1"	"1637396-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Family states patient never recovered after 2nd Moderna dose.  Entered hospital with extreme shortness of breath.  Ventilated after several days.  Passed away while in hospital."
	"1637396-1"	"1637396-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Family states patient never recovered after 2nd Moderna dose.  Entered hospital with extreme shortness of breath.  Ventilated after several days.  Passed away while in hospital."
	"1637396-1"	"1637396-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Family states patient never recovered after 2nd Moderna dose.  Entered hospital with extreme shortness of breath.  Ventilated after several days.  Passed away while in hospital."
	"1658929-1"	"1658929-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 07/25/2021."
	"1659238-1"	"1659238-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient completed Covid vaccination series on 2/19/2021, then was hospitalized for Covid on 8/21/2021 and died of Covid 8/30/2021."
	"1659238-1"	"1659238-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient completed Covid vaccination series on 2/19/2021, then was hospitalized for Covid on 8/21/2021 and died of Covid 8/30/2021."
	"1659238-1"	"1659238-1"	"SARS-COV-2 RNA"	"10085493"	"65-79 years"	"65-79"	"Patient completed Covid vaccination series on 2/19/2021, then was hospitalized for Covid on 8/21/2021 and died of Covid 8/30/2021."
	"1659238-1"	"1659238-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient completed Covid vaccination series on 2/19/2021, then was hospitalized for Covid on 8/21/2021 and died of Covid 8/30/2021."
	"1662348-1"	"1662348-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"32 hours after patient obtained the 2nd vaccine, he began to seriously decline and died the next day. He was on hospice and his death was eventually inevitable due to his lung cancer, but I am reporting this event as his death occurred so close to administration of the vaccine."
	"1662348-1"	"1662348-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"32 hours after patient obtained the 2nd vaccine, he began to seriously decline and died the next day. He was on hospice and his death was eventually inevitable due to his lung cancer, but I am reporting this event as his death occurred so close to administration of the vaccine."
	"1662348-1"	"1662348-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"32 hours after patient obtained the 2nd vaccine, he began to seriously decline and died the next day. He was on hospice and his death was eventually inevitable due to his lung cancer, but I am reporting this event as his death occurred so close to administration of the vaccine."
	"1662348-1"	"1662348-1"	"LUNG NEOPLASM MALIGNANT"	"10058467"	"65-79 years"	"65-79"	"32 hours after patient obtained the 2nd vaccine, he began to seriously decline and died the next day. He was on hospice and his death was eventually inevitable due to his lung cancer, but I am reporting this event as his death occurred so close to administration of the vaccine."
	"1662426-1"	"1662426-1"	"BILEVEL POSITIVE AIRWAY PRESSURE"	"10064530"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"BLOOD GASES ABNORMAL"	"10005539"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"CARBON DIOXIDE DECREASED"	"10007223"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"CELLULITIS"	"10007882"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"CULTURE WOUND POSITIVE"	"10011643"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"ENCEPHALOPATHY"	"10014625"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"FALL"	"10016173"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"FIBULA FRACTURE"	"10016667"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"GENERALISED OEDEMA"	"10018092"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"HYPOPHAGIA"	"10063743"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"LETHARGY"	"10024264"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"OEDEMA"	"10030095"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"PAIN IN EXTREMITY"	"10033425"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"PERIPHERAL VENOUS DISEASE"	"10075049"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"PULSE ABSENT"	"10037469"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"SEIZURE"	"10039906"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"STAPHYLOCOCCAL INFECTION"	"10058080"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"WEIGHT INCREASED"	"10047899"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1662426-1"	"1662426-1"	"X-RAY LIMB"	"10061585"	"65-79 years"	"65-79"	"Patient hospitalized;  positive for COVID-19 (after vaccinated);  patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive.  Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated.  Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy:  Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection.  VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely.  Only Norco was restarted.  Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis:  Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema.  Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top.  Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course.  Cellulitis gradually was improving; COVID-19 infection:  Incidentally noted at rehab on 08/22,  patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated.  Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here.  Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease:  With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty.  There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay.  Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV  Lasix/diureses were started.  Her renal function mostly was holding in spite of aggressive diureses and slow weight loss.  This was also noted in the lower extremities with improvement in the edema. On 08/28,  during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared  unwell and lost her pulse is.  All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m..  Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed."
	"1666464-1"	"1666464-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Admitted 8/25/2021 SOB, cough"
	"1666464-1"	"1666464-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Admitted 8/25/2021 SOB, cough"
	"1666464-1"	"1666464-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Admitted 8/25/2021 SOB, cough"
	"1666464-1"	"1666464-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Admitted 8/25/2021 SOB, cough"
	"1670460-1"	"1670460-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"August 29, 2021 patient with NO HISTORY OF SEIZURES had a seizure in the Emergency Room of Hospital.  Patient was treated with Keppra for seizure.  On August 31, 2021 patient had another seizure and died."
	"1670460-1"	"1670460-1"	"SEIZURE"	"10039906"	"65-79 years"	"65-79"	"August 29, 2021 patient with NO HISTORY OF SEIZURES had a seizure in the Emergency Room of Hospital.  Patient was treated with Keppra for seizure.  On August 31, 2021 patient had another seizure and died."
	"1678499-1"	"1678499-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Vaccine breakthrough, symptomatic.   Inpatient admit 8/23-9/5.   Expired."
	"1678499-1"	"1678499-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"Vaccine breakthrough, symptomatic.   Inpatient admit 8/23-9/5.   Expired."
	"1678823-1"	"1678823-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"CARDIOVERSION"	"10007661"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"CEREBRAL INFARCTION"	"10008118"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"ELECTROENCEPHALOGRAM ABNORMAL"	"10014408"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"ENCEPHALOPATHY"	"10014625"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"FEEDING INTOLERANCE"	"10076042"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"GASTROINTESTINAL NECROSIS"	"10017982"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"GASTROSTOMY"	"10048978"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"ISCHAEMIA"	"10061255"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"JEJUNOSTOMY"	"10023180"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"LOSS OF CONSCIOUSNESS"	"10024855"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"MAGNETIC RESONANCE IMAGING HEAD ABNORMAL"	"10085256"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"PALLIATIVE CARE"	"10059513"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"SURGERY"	"10042609"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"THERAPEUTIC HYPOTHERMIA"	"10059485"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1678823-1"	"1678823-1"	"WEAN FROM VENTILATOR"	"10056353"	"65-79 years"	"65-79"	""Fully vaccinated patient who tested positive for COVID with admission testing to hospital.  Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock.  Patient intubated upon arrival to ED and provided hypothermia protocol.  Patient did not have return of consciousness.  Encephalopathy and acute to subacute brain infarct per MRI and ""severe diffuse encephalopathy"" per EEG. Family requesting continuation of ""aggressive care.""  PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia.  Family meeting including Palliative Care team and family chose to change to comfort care.  Patient was removed from ventilator on 06/24/21 and died shortly after.""
	"1685087-1"	"1685087-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient diagnosed, hospitalized and expired with COVID 19 while fully vaccinated"
	"1685087-1"	"1685087-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient diagnosed, hospitalized and expired with COVID 19 while fully vaccinated"
	"1685155-1"	"1685155-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient diagnosed and hospitalized with COVID 19. Patient expired."
	"1685155-1"	"1685155-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient diagnosed and hospitalized with COVID 19. Patient expired."
	"1694955-1"	"1694955-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"HOSPITALIZATION AND DEATH RELATED TO COVID-19 AFTER BEING FULLY VACCINATED"
	"1694955-1"	"1694955-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"HOSPITALIZATION AND DEATH RELATED TO COVID-19 AFTER BEING FULLY VACCINATED"
	"1694955-1"	"1694955-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"HOSPITALIZATION AND DEATH RELATED TO COVID-19 AFTER BEING FULLY VACCINATED"
	"1696431-1"	"1696431-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"COVID INFECTION WITH HOSPITALIZATION AND DEATH WHILE FULLY VACCINATED"
	"1696431-1"	"1696431-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"COVID INFECTION WITH HOSPITALIZATION AND DEATH WHILE FULLY VACCINATED"
	"1696431-1"	"1696431-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"COVID INFECTION WITH HOSPITALIZATION AND DEATH WHILE FULLY VACCINATED"
	"1704279-1"	"1704279-1"	"ASPIRATION"	"10003504"	"65-79 years"	"65-79"	"Covid vaccine dose #1 2/10/2021 Moderna Lot # 024m20A dose #2 3/1/2021,  Moderna, lot # n/a  pt died on 9/16/2021 in the hospital from cardiac arrest, aspiration, prolonged hospitalizations for chronic illnesses, not a covid related death."
	"1704279-1"	"1704279-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Covid vaccine dose #1 2/10/2021 Moderna Lot # 024m20A dose #2 3/1/2021,  Moderna, lot # n/a  pt died on 9/16/2021 in the hospital from cardiac arrest, aspiration, prolonged hospitalizations for chronic illnesses, not a covid related death."
	"1704279-1"	"1704279-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Covid vaccine dose #1 2/10/2021 Moderna Lot # 024m20A dose #2 3/1/2021,  Moderna, lot # n/a  pt died on 9/16/2021 in the hospital from cardiac arrest, aspiration, prolonged hospitalizations for chronic illnesses, not a covid related death."
	"1704279-1"	"1704279-1"	"INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION"	"10081572"	"65-79 years"	"65-79"	"Covid vaccine dose #1 2/10/2021 Moderna Lot # 024m20A dose #2 3/1/2021,  Moderna, lot # n/a  pt died on 9/16/2021 in the hospital from cardiac arrest, aspiration, prolonged hospitalizations for chronic illnesses, not a covid related death."
	"1708822-1"	"1708822-1"	"AGITATION"	"10001497"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"BLOOD CULTURE NEGATIVE"	"10005486"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"BLOOD LACTIC ACID INCREASED"	"10005635"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"COGNITIVE DISORDER"	"10057668"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"CULTURE URINE NEGATIVE"	"10011639"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"CULTURE URINE POSITIVE"	"10011640"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"DELIRIUM"	"10012218"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"DEMENTIA"	"10012267"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"HYPOMAGNESAEMIA"	"10021027"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"SEPSIS"	"10040047"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"SYSTEMIC INFLAMMATORY RESPONSE SYNDROME"	"10051379"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"TREMOR"	"10044565"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"URINARY INCONTINENCE"	"10046543"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"URINARY TRACT INFECTION"	"10046571"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708822-1"	"1708822-1"	"WHITE BLOOD CELL COUNT INCREASED"	"10047943"	"65-79 years"	"65-79"	"Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia;  COVID-19 positive 9.10.21;  fully vaccinated Date of Death: 9/15/21 Time of Death:  1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition:  expired   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19   HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness.  He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid.  He had a UTI and was discharged home on the 8th.  He returned 2 days later and was positive for covid and had hypoxia with CXR findings.  He was admitted for the treatment of covid pneumonia dn started on dexamethasone.  Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring.  Family stayed with him which did not help.  They decided to change his goals of care and talked to hospice.  He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx  With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)"
	"1708831-1"	"1708831-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Diagnosed, hospitalized and expired with COVID 19- fully vaccinated"
	"1708831-1"	"1708831-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Diagnosed, hospitalized and expired with COVID 19- fully vaccinated"
	"1715223-1"	"1715223-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Patient was hospitalized with COVID-19 symptoms on 8/26/2021 with respiratory failure. Patient was subsequently intubated and mechanically ventilated for a total of 17 days before being make compassionate care by family on 9/14/2021."
	"1715223-1"	"1715223-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Patient was hospitalized with COVID-19 symptoms on 8/26/2021 with respiratory failure. Patient was subsequently intubated and mechanically ventilated for a total of 17 days before being make compassionate care by family on 9/14/2021."
	"1715223-1"	"1715223-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Patient was hospitalized with COVID-19 symptoms on 8/26/2021 with respiratory failure. Patient was subsequently intubated and mechanically ventilated for a total of 17 days before being make compassionate care by family on 9/14/2021."
	"1715223-1"	"1715223-1"	"RESPIRATORY FAILURE"	"10038695"	"65-79 years"	"65-79"	"Patient was hospitalized with COVID-19 symptoms on 8/26/2021 with respiratory failure. Patient was subsequently intubated and mechanically ventilated for a total of 17 days before being make compassionate care by family on 9/14/2021."
	"1715267-1"	"1715267-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Shortness of breath."
	"1715844-1"	"1715844-1"	"BLOOD PH INCREASED"	"10005708"	"65-79 years"	"65-79"	"worsening dyspnea, required high flow oxygen, declined intubation, passed away"
	"1715844-1"	"1715844-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"worsening dyspnea, required high flow oxygen, declined intubation, passed away"
	"1715844-1"	"1715844-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"worsening dyspnea, required high flow oxygen, declined intubation, passed away"
	"1715844-1"	"1715844-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"worsening dyspnea, required high flow oxygen, declined intubation, passed away"
	"1715844-1"	"1715844-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"worsening dyspnea, required high flow oxygen, declined intubation, passed away"
	"1715844-1"	"1715844-1"	"REFUSAL OF TREATMENT BY PATIENT"	"10056407"	"65-79 years"	"65-79"	"worsening dyspnea, required high flow oxygen, declined intubation, passed away"
	"1715844-1"	"1715844-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"worsening dyspnea, required high flow oxygen, declined intubation, passed away"
	"1718996-1"	"1718996-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Patient received a 3rd dose of Moderna vaccine on 09/01/2021. Patient passed away on 09/11/2021 from cardiac arrest."
	"1718996-1"	"1718996-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received a 3rd dose of Moderna vaccine on 09/01/2021. Patient passed away on 09/11/2021 from cardiac arrest."
	"1718996-1"	"1718996-1"	"EXTRA DOSE ADMINISTERED"	"10064366"	"65-79 years"	"65-79"	"Patient received a 3rd dose of Moderna vaccine on 09/01/2021. Patient passed away on 09/11/2021 from cardiac arrest."
	"1719457-1"	"1719457-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"patient expired 9/18/2021"
	"1726306-1"	"1726306-1"	"ACUTE HEPATIC FAILURE"	"10000804"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"AMMONIA NORMAL"	"10001947"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"ARTHRALGIA"	"10003239"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"ARTHRITIS BACTERIAL"	"10053555"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"ASYMPTOMATIC COVID-19"	"10084459"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"BACTERAEMIA"	"10003997"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"BLINDNESS"	"10005169"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"BLINDNESS UNILATERAL"	"10005186"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"BLOOD BILIRUBIN ABNORMAL"	"10058477"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"CEREBROVASCULAR ACCIDENT"	"10008190"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"COMPUTERISED TOMOGRAM HEAD NORMAL"	"10072167"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"CONFUSIONAL STATE"	"10010305"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"ECHOCARDIOGRAM"	"10014113"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"HEPATIC CIRRHOSIS"	"10019641"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"HEPATIC ENCEPHALOPATHY"	"10019660"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"HEPATITIS B TEST NEGATIVE"	"10065002"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"HEPATITIS C TEST NEGATIVE"	"10065001"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"HYPERKALAEMIA"	"10020646"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"HYPONATRAEMIA"	"10021036"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"IRITIS"	"10022955"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"JOINT FLUID DRAINAGE"	"10066994"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"JOINT INJURY"	"10060820"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"JOINT SWELLING"	"10023232"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"LETHARGY"	"10024264"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"LIGAMENT SPRAIN"	"10024453"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"LIVER FUNCTION TEST ABNORMAL"	"10024690"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"STAPHYLOCOCCAL SEPSIS"	"10056430"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726306-1"	"1726306-1"	"X-RAY LIMB NORMAL"	"10061587"	"65-79 years"	"65-79"	"Hospitalized (9.2.21);  Deceased (9.17.21);  COVID-19 positive;  Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death:  3:30 PM Preliminary Cause of Death: Bacteremia       Discharge Disposition:  death   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury)   HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss.  The patient's wife is at bedside and provides aspects of history.  8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA.  On Ancef with plan to continue 6 weeks course.   His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations.  Unfortunately patient developed worsening LFTs and bilirubin.  Gastroenterology was consulted.  It is noted that patient had cirrhosis have baseline etiology unclear.  Hepatitis-C and hepatitis-B workup were negative.  Imaging did not show thrombus.  Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol.  These medications were discontinued but LFTs continue to trend up.  There was also concern for Bilateral endogenous endophthalmitis.  IV Ancef was discontinued and patient was started on IV vancomycin and linezolid.  Unfortunately this led to acute kidney injury with high vancomycin trough level.  Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued.  Unfortunately patient continued to decline and have further elevation in bilirubin levels.  Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis.  Renal function also continued to decline with subsequent noted hyperkalemia.  Given patient's overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16.  Palliative Care was consulted and assisted with medication.  Patient was placed on a fentanyl drip.  Physician was called that patient passed away at 3:30 p.m. 09/17/2021.  Patient officially pronounced on 15:50 on 09/17/2021.  Family present in room."
	"1726490-1"	"1726490-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"COVID positive, admitted 9/9 for worsening hypoxia, deceased 9/10 while admitted. Fully vaccinated March 2021."
	"1726490-1"	"1726490-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"COVID positive, admitted 9/9 for worsening hypoxia, deceased 9/10 while admitted. Fully vaccinated March 2021."
	"1726490-1"	"1726490-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"COVID positive, admitted 9/9 for worsening hypoxia, deceased 9/10 while admitted. Fully vaccinated March 2021."
	"1726490-1"	"1726490-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"COVID positive, admitted 9/9 for worsening hypoxia, deceased 9/10 while admitted. Fully vaccinated March 2021."
	"1730336-1"	"1730336-1"	"APPLICATION SITE VESICLES"	"10048941"	"65-79 years"	"65-79"	"Clot in his Heart due to the Vaccine; A small Bubble in the Injection site; This spontaneous case was reported by a consumer and describes the occurrence of INTRACARDIAC THROMBUS (Clot in his Heart due to the Vaccine) in a 74-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 092D21A and 059E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.   On 09-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 05-Sep-2021, the patient experienced APPLICATION SITE VESICLES (A small Bubble in the Injection site). On 06-Sep-2021, the patient experienced INTRACARDIAC THROMBUS (Clot in his Heart due to the Vaccine) (seriousness criteria death and medically significant). The patient died on 06-Sep-2021. The reported cause of death was clot in his heart due to the vaccine. It is unknown if an autopsy was performed. At the time of death, APPLICATION SITE VESICLES (A small Bubble in the Injection site) outcome was unknown.            Concomitant product use was not provided by the reporter.  The patient died in his sleep after 24 hours of getting his second dose of the Moderna Covid-19 vaccine. The patient did not have any existing medical condition and the cause of death indicated on death certificate was a clot in his heart due to the vaccine. Patient only had a small bubble in the injection site.  No treatment information was provided.  Company comment: This fatal case concerns a 74-year-old male patient with no medical history reported, who experienced the serious unexpected event Intracardiac thrombosis .The event occurred approximately 28 days after the first dose and one day after the second and most recent dose of mRNA-1273 Moderna vaccine. The reported cause of death was clot in his heart due to the vaccine. It is unknown if an autopsy was performed. Further information has been requested. The benefit-risk relationship of mRNA-1273 Moderna vaccine is not affected by this report.; Sender's Comments: This fatal case concerns a 74-year-old male patient with no medical history reported, who experienced the serious unexpected event Intracardiac thrombosis .The event occurred approximately 28 days after the first dose and one day after the second and most recent dose of mRNA-1273 Moderna vaccine. The reported cause of death was clot in his heart due to the vaccine. It is unknown if an autopsy was performed. Further information has been requested. The benefit-risk relationship of mRNA-1273 Moderna vaccine is not affected by this report.; Reported Cause(s) of Death: Clot in his Heart due to the Vaccine"
	"1730336-1"	"1730336-1"	"INTRACARDIAC THROMBUS"	"10048620"	"65-79 years"	"65-79"	"Clot in his Heart due to the Vaccine; A small Bubble in the Injection site; This spontaneous case was reported by a consumer and describes the occurrence of INTRACARDIAC THROMBUS (Clot in his Heart due to the Vaccine) in a 74-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 092D21A and 059E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.   On 09-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 05-Sep-2021, the patient experienced APPLICATION SITE VESICLES (A small Bubble in the Injection site). On 06-Sep-2021, the patient experienced INTRACARDIAC THROMBUS (Clot in his Heart due to the Vaccine) (seriousness criteria death and medically significant). The patient died on 06-Sep-2021. The reported cause of death was clot in his heart due to the vaccine. It is unknown if an autopsy was performed. At the time of death, APPLICATION SITE VESICLES (A small Bubble in the Injection site) outcome was unknown.            Concomitant product use was not provided by the reporter.  The patient died in his sleep after 24 hours of getting his second dose of the Moderna Covid-19 vaccine. The patient did not have any existing medical condition and the cause of death indicated on death certificate was a clot in his heart due to the vaccine. Patient only had a small bubble in the injection site.  No treatment information was provided.  Company comment: This fatal case concerns a 74-year-old male patient with no medical history reported, who experienced the serious unexpected event Intracardiac thrombosis .The event occurred approximately 28 days after the first dose and one day after the second and most recent dose of mRNA-1273 Moderna vaccine. The reported cause of death was clot in his heart due to the vaccine. It is unknown if an autopsy was performed. Further information has been requested. The benefit-risk relationship of mRNA-1273 Moderna vaccine is not affected by this report.; Sender's Comments: This fatal case concerns a 74-year-old male patient with no medical history reported, who experienced the serious unexpected event Intracardiac thrombosis .The event occurred approximately 28 days after the first dose and one day after the second and most recent dose of mRNA-1273 Moderna vaccine. The reported cause of death was clot in his heart due to the vaccine. It is unknown if an autopsy was performed. Further information has been requested. The benefit-risk relationship of mRNA-1273 Moderna vaccine is not affected by this report.; Reported Cause(s) of Death: Clot in his Heart due to the Vaccine"
	"1736750-1"	"1736750-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient is a 71-year-old male with a past medical history of COPD, bronchiectasis, asthma, dilated cardiomyopathy, last ejection fraction 20% who presents to our facility with concerns of dyspnea, malaise, fatigue. Symptoms present for the last 3 days. Of note, patient recently admitted to her SOB for similar complaints. At this time he did not have COVID. He presents to our facility hypotensive with heart rate near 150s. He currently denies chest pain but admits to mild increased work of breathing and shortness of breath. No nausea, vomiting, or abdominal pain. He follows up with his cardiologist. He is currently on torsemide daily which was switched by his cardiologist on the 23rd. He is compliant with his other medications. He was recently started on entresto."
	"1736750-1"	"1736750-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"Patient is a 71-year-old male with a past medical history of COPD, bronchiectasis, asthma, dilated cardiomyopathy, last ejection fraction 20% who presents to our facility with concerns of dyspnea, malaise, fatigue. Symptoms present for the last 3 days. Of note, patient recently admitted to her SOB for similar complaints. At this time he did not have COVID. He presents to our facility hypotensive with heart rate near 150s. He currently denies chest pain but admits to mild increased work of breathing and shortness of breath. No nausea, vomiting, or abdominal pain. He follows up with his cardiologist. He is currently on torsemide daily which was switched by his cardiologist on the 23rd. He is compliant with his other medications. He was recently started on entresto."
	"1736750-1"	"1736750-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	"Patient is a 71-year-old male with a past medical history of COPD, bronchiectasis, asthma, dilated cardiomyopathy, last ejection fraction 20% who presents to our facility with concerns of dyspnea, malaise, fatigue. Symptoms present for the last 3 days. Of note, patient recently admitted to her SOB for similar complaints. At this time he did not have COVID. He presents to our facility hypotensive with heart rate near 150s. He currently denies chest pain but admits to mild increased work of breathing and shortness of breath. No nausea, vomiting, or abdominal pain. He follows up with his cardiologist. He is currently on torsemide daily which was switched by his cardiologist on the 23rd. He is compliant with his other medications. He was recently started on entresto."
	"1736750-1"	"1736750-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Patient is a 71-year-old male with a past medical history of COPD, bronchiectasis, asthma, dilated cardiomyopathy, last ejection fraction 20% who presents to our facility with concerns of dyspnea, malaise, fatigue. Symptoms present for the last 3 days. Of note, patient recently admitted to her SOB for similar complaints. At this time he did not have COVID. He presents to our facility hypotensive with heart rate near 150s. He currently denies chest pain but admits to mild increased work of breathing and shortness of breath. No nausea, vomiting, or abdominal pain. He follows up with his cardiologist. He is currently on torsemide daily which was switched by his cardiologist on the 23rd. He is compliant with his other medications. He was recently started on entresto."
	"1736750-1"	"1736750-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	"Patient is a 71-year-old male with a past medical history of COPD, bronchiectasis, asthma, dilated cardiomyopathy, last ejection fraction 20% who presents to our facility with concerns of dyspnea, malaise, fatigue. Symptoms present for the last 3 days. Of note, patient recently admitted to her SOB for similar complaints. At this time he did not have COVID. He presents to our facility hypotensive with heart rate near 150s. He currently denies chest pain but admits to mild increased work of breathing and shortness of breath. No nausea, vomiting, or abdominal pain. He follows up with his cardiologist. He is currently on torsemide daily which was switched by his cardiologist on the 23rd. He is compliant with his other medications. He was recently started on entresto."
	"1736876-1"	"1736876-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"ONSET 09/13/2021 WITH SOB, MYALGIA, RHINORRHEA, OLFACTORY/TASTE DISORDER, FATIGUE, COUGH, FEVER 102.6, NAUSEA RESULTING IN ICU HOSPITALIZATION AND DEATH"
	"1736876-1"	"1736876-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"ONSET 09/13/2021 WITH SOB, MYALGIA, RHINORRHEA, OLFACTORY/TASTE DISORDER, FATIGUE, COUGH, FEVER 102.6, NAUSEA RESULTING IN ICU HOSPITALIZATION AND DEATH"
	"1736876-1"	"1736876-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"ONSET 09/13/2021 WITH SOB, MYALGIA, RHINORRHEA, OLFACTORY/TASTE DISORDER, FATIGUE, COUGH, FEVER 102.6, NAUSEA RESULTING IN ICU HOSPITALIZATION AND DEATH"
	"1736876-1"	"1736876-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"ONSET 09/13/2021 WITH SOB, MYALGIA, RHINORRHEA, OLFACTORY/TASTE DISORDER, FATIGUE, COUGH, FEVER 102.6, NAUSEA RESULTING IN ICU HOSPITALIZATION AND DEATH"
	"1736876-1"	"1736876-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"ONSET 09/13/2021 WITH SOB, MYALGIA, RHINORRHEA, OLFACTORY/TASTE DISORDER, FATIGUE, COUGH, FEVER 102.6, NAUSEA RESULTING IN ICU HOSPITALIZATION AND DEATH"
	"1736876-1"	"1736876-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"ONSET 09/13/2021 WITH SOB, MYALGIA, RHINORRHEA, OLFACTORY/TASTE DISORDER, FATIGUE, COUGH, FEVER 102.6, NAUSEA RESULTING IN ICU HOSPITALIZATION AND DEATH"
	"1736876-1"	"1736876-1"	"MYALGIA"	"10028411"	"65-79 years"	"65-79"	"ONSET 09/13/2021 WITH SOB, MYALGIA, RHINORRHEA, OLFACTORY/TASTE DISORDER, FATIGUE, COUGH, FEVER 102.6, NAUSEA RESULTING IN ICU HOSPITALIZATION AND DEATH"
	"1736876-1"	"1736876-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"ONSET 09/13/2021 WITH SOB, MYALGIA, RHINORRHEA, OLFACTORY/TASTE DISORDER, FATIGUE, COUGH, FEVER 102.6, NAUSEA RESULTING IN ICU HOSPITALIZATION AND DEATH"
	"1736876-1"	"1736876-1"	"PAROSMIA"	"10034018"	"65-79 years"	"65-79"	"ONSET 09/13/2021 WITH SOB, MYALGIA, RHINORRHEA, OLFACTORY/TASTE DISORDER, FATIGUE, COUGH, FEVER 102.6, NAUSEA RESULTING IN ICU HOSPITALIZATION AND DEATH"
	"1736876-1"	"1736876-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"ONSET 09/13/2021 WITH SOB, MYALGIA, RHINORRHEA, OLFACTORY/TASTE DISORDER, FATIGUE, COUGH, FEVER 102.6, NAUSEA RESULTING IN ICU HOSPITALIZATION AND DEATH"
	"1736876-1"	"1736876-1"	"RHINORRHOEA"	"10039101"	"65-79 years"	"65-79"	"ONSET 09/13/2021 WITH SOB, MYALGIA, RHINORRHEA, OLFACTORY/TASTE DISORDER, FATIGUE, COUGH, FEVER 102.6, NAUSEA RESULTING IN ICU HOSPITALIZATION AND DEATH"
	"1736876-1"	"1736876-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"ONSET 09/13/2021 WITH SOB, MYALGIA, RHINORRHEA, OLFACTORY/TASTE DISORDER, FATIGUE, COUGH, FEVER 102.6, NAUSEA RESULTING IN ICU HOSPITALIZATION AND DEATH"
	"1736876-1"	"1736876-1"	"TASTE DISORDER"	"10082490"	"65-79 years"	"65-79"	"ONSET 09/13/2021 WITH SOB, MYALGIA, RHINORRHEA, OLFACTORY/TASTE DISORDER, FATIGUE, COUGH, FEVER 102.6, NAUSEA RESULTING IN ICU HOSPITALIZATION AND DEATH"
	"1737140-1"	"1737140-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Diagnosed, hospitalized and expired from COVID-19"
	"1737140-1"	"1737140-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Diagnosed, hospitalized and expired from COVID-19"
	"1737143-1"	"1737143-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"unknown"
	"1737160-1"	"1737160-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Diagnosed, hospitalized and expired from COVID"
	"1737160-1"	"1737160-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Diagnosed, hospitalized and expired from COVID"
	"1737230-1"	"1737230-1"	"ABDOMINAL PAIN"	"10000081"	"65-79 years"	"65-79"	"On 06/02/2021 my father started having extreme abdominal pain. He visited er and was sent home with a surgeon follow up in one week. They said he had a hernia However no hernia was noted on autopsy report. He died suddenly on the morning of 6/9/2021 just before surgeon appointment"
	"1737230-1"	"1737230-1"	"AUTOPSY"	"10050117"	"65-79 years"	"65-79"	"On 06/02/2021 my father started having extreme abdominal pain. He visited er and was sent home with a surgeon follow up in one week. They said he had a hernia However no hernia was noted on autopsy report. He died suddenly on the morning of 6/9/2021 just before surgeon appointment"
	"1737230-1"	"1737230-1"	"CHEST X-RAY"	"10008498"	"65-79 years"	"65-79"	"On 06/02/2021 my father started having extreme abdominal pain. He visited er and was sent home with a surgeon follow up in one week. They said he had a hernia However no hernia was noted on autopsy report. He died suddenly on the morning of 6/9/2021 just before surgeon appointment"
	"1737230-1"	"1737230-1"	"HERNIA"	"10019909"	"65-79 years"	"65-79"	"On 06/02/2021 my father started having extreme abdominal pain. He visited er and was sent home with a surgeon follow up in one week. They said he had a hernia However no hernia was noted on autopsy report. He died suddenly on the morning of 6/9/2021 just before surgeon appointment"
	"1737230-1"	"1737230-1"	"LABORATORY TEST"	"10059938"	"65-79 years"	"65-79"	"On 06/02/2021 my father started having extreme abdominal pain. He visited er and was sent home with a surgeon follow up in one week. They said he had a hernia However no hernia was noted on autopsy report. He died suddenly on the morning of 6/9/2021 just before surgeon appointment"
	"1737230-1"	"1737230-1"	"SUDDEN DEATH"	"10042434"	"65-79 years"	"65-79"	"On 06/02/2021 my father started having extreme abdominal pain. He visited er and was sent home with a surgeon follow up in one week. They said he had a hernia However no hernia was noted on autopsy report. He died suddenly on the morning of 6/9/2021 just before surgeon appointment"
	"1737367-1"	"1737367-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"On 8/28/21 after patient had been fully vaccinated, Patient became COVID positive. On 8/30/21, her respiratory status declined and she was admitted to Hospital. On 9/18/21 while still admitted as inpatient, she declined and required mechanical ventilation and ICU care. On 9/22/21 case died."
	"1737367-1"	"1737367-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"On 8/28/21 after patient had been fully vaccinated, Patient became COVID positive. On 8/30/21, her respiratory status declined and she was admitted to Hospital. On 9/18/21 while still admitted as inpatient, she declined and required mechanical ventilation and ICU care. On 9/22/21 case died."
	"1737367-1"	"1737367-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"On 8/28/21 after patient had been fully vaccinated, Patient became COVID positive. On 8/30/21, her respiratory status declined and she was admitted to Hospital. On 9/18/21 while still admitted as inpatient, she declined and required mechanical ventilation and ICU care. On 9/22/21 case died."
	"1737367-1"	"1737367-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"On 8/28/21 after patient had been fully vaccinated, Patient became COVID positive. On 8/30/21, her respiratory status declined and she was admitted to Hospital. On 9/18/21 while still admitted as inpatient, she declined and required mechanical ventilation and ICU care. On 9/22/21 case died."
	"1737367-1"	"1737367-1"	"RESPIRATORY DISORDER"	"10038683"	"65-79 years"	"65-79"	"On 8/28/21 after patient had been fully vaccinated, Patient became COVID positive. On 8/30/21, her respiratory status declined and she was admitted to Hospital. On 9/18/21 while still admitted as inpatient, she declined and required mechanical ventilation and ICU care. On 9/22/21 case died."
	"1737367-1"	"1737367-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"On 8/28/21 after patient had been fully vaccinated, Patient became COVID positive. On 8/30/21, her respiratory status declined and she was admitted to Hospital. On 9/18/21 while still admitted as inpatient, she declined and required mechanical ventilation and ICU care. On 9/22/21 case died."
	"1741301-1"	"1741301-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received first dose of COVID-19 vaccine on 8/30/2021.  Patient was then hospitalized on 9/7/2021 with COVID-19 symptoms.  Patient was a no code/no intubation at admission.  Patient ultimately progressed to high flow oxygen  and was made compassionate care and passed away on 9/19/2021."
	"1741301-1"	"1741301-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Patient received first dose of COVID-19 vaccine on 8/30/2021.  Patient was then hospitalized on 9/7/2021 with COVID-19 symptoms.  Patient was a no code/no intubation at admission.  Patient ultimately progressed to high flow oxygen  and was made compassionate care and passed away on 9/19/2021."
	"1741301-1"	"1741301-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Patient received first dose of COVID-19 vaccine on 8/30/2021.  Patient was then hospitalized on 9/7/2021 with COVID-19 symptoms.  Patient was a no code/no intubation at admission.  Patient ultimately progressed to high flow oxygen  and was made compassionate care and passed away on 9/19/2021."
	"1745753-1"	"1745753-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient was a breakthrough COVID case and died due to COVID-related causes on 8/18/2021."
	"1745753-1"	"1745753-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient was a breakthrough COVID case and died due to COVID-related causes on 8/18/2021."
	"1745753-1"	"1745753-1"	"SARS-COV-2 TEST"	"10084354"	"65-79 years"	"65-79"	"Patient was a breakthrough COVID case and died due to COVID-related causes on 8/18/2021."
	"1745753-1"	"1745753-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"Patient was a breakthrough COVID case and died due to COVID-related causes on 8/18/2021."
	"1753250-1"	"1753250-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"ANTICOAGULANT THERAPY"	"10053468"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"ANXIETY"	"10002855"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"ARTHRALGIA"	"10003239"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"BLOOD CULTURE NEGATIVE"	"10005486"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"BURSITIS"	"10006811"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"CORONARY ARTERY THROMBOSIS"	"10011091"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"CULTURE NEGATIVE"	"10061448"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"HYPERVOLAEMIA"	"10020919"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"LABORATORY TEST NORMAL"	"10054052"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"LUMBAR RADICULOPATHY"	"10050219"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"POSITIVE AIRWAY PRESSURE THERAPY"	"10086397"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"ROTATOR CUFF REPAIR"	"10050324"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"TACHYCARDIA"	"10043071"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1753250-1"	"1753250-1"	"ULTRASOUND DOPPLER ABNORMAL"	"10045413"	"65-79 years"	"65-79"	"Deceased (9.26.21);  Hospitalized due to COVID-19 (9.2.21);  COVID-19 positive (8.31.21);  Fully vaccinated   Admission Date: 9/2/2021 Died 9/26/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] Acute hypoxemic respiratory failure (HCC) [J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a PMHx of COPD not on home oxygen, HTN, Hypothyroid, RA on immunomodulator therapy who was admitted for AHRF secondary to Covid pneumonia. Completed 4 days of dexamethasone, 3 days of remdesivir so far. Bcx, other infectious work-up have been negative. Going intermittently between HFNC and BiPAP, stays relatively comfortable without additional work of breathing. She has been responding well to once/day diuresis. Multiple conversations at that time were held with the patient, who has elected to be DNR/DNI - okay with vasopressor medications if needed. After transfer out of the ICU she completed dexamethasone, remdesivir, diuresis as needed- she developed an AkI that resolved. She was able to alternate between HFNC and BiPAP but developed hypoxia despite continuous BiPAP at 100%. She was readmitted to the ICU on 9/11 and was unsure of her code status to be DNR or FULL. Overnight she remained on continuous BiPAP with O2 sats in the high 80s. A CTA to rule out PE was unable to be performed given her respiratory status, U/S showed no signsof DVT. On 9/12 Patient had increased work of breathing and anxiety, especially with repositioning and requested to be FULL CODE and was electively intubated for hypoxic respiratory failure 2/2 COVID-19 PNA.    Following intubation, the patient did develop worsening urine output and AKI.  She ultimately was started on CRRT for volume overload.  With volume overload, her O2 requirement did improve somewhat, but she still had significant ventilatory needs due to her COVID-19 pneumonia.  Patient also had persistent tachycardia during her hospital stay.  Her serotonergic medications were held to rule out serotonin syndrome, repeat cultures were obtained without any growth, and extremity ultrasounds were performed which did show equivocal left coronal DVT.  Patient was started on heparin drip for this possible DVT.   Due to the persistent high ventilatory needs, goals of care were discussed with the family.  It was agreed that tracheostomy tube placement was not in line with the patient's goals of care, and due to her persistent refractory hypoxemia requiring high ventilatory needs, plan was made to transition patient to comfort care on Monday, 09/27/2021. On Sunday 9/26 patient had acute worsening in clinical status with decreasing oxygen levels. Based on patient's families wishes for the patient to be with her husband upon passing the patient was made comfort care and passed away at 1108 AM. Date of Death: 9/26/21 Time of Death: 11:08 AM Preliminary Cause of Death: COVID-19"
	"1759418-1"	"1759418-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Fully COVID vaccinated patient who admitted through emergency department with COVID positive test on 09/19/21.  Patients respiratory status continued to decline, he required CCU admission high flow oxygen, and subsquently BiPAP.  Medical team reviewed ongoing respiratory decline and grave status with patient and family who declined intubation.  Patient moved to comfort care and died on 10/02/21."
	"1759418-1"	"1759418-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Fully COVID vaccinated patient who admitted through emergency department with COVID positive test on 09/19/21.  Patients respiratory status continued to decline, he required CCU admission high flow oxygen, and subsquently BiPAP.  Medical team reviewed ongoing respiratory decline and grave status with patient and family who declined intubation.  Patient moved to comfort care and died on 10/02/21."
	"1759418-1"	"1759418-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Fully COVID vaccinated patient who admitted through emergency department with COVID positive test on 09/19/21.  Patients respiratory status continued to decline, he required CCU admission high flow oxygen, and subsquently BiPAP.  Medical team reviewed ongoing respiratory decline and grave status with patient and family who declined intubation.  Patient moved to comfort care and died on 10/02/21."
	"1759418-1"	"1759418-1"	"POSITIVE AIRWAY PRESSURE THERAPY"	"10086397"	"65-79 years"	"65-79"	"Fully COVID vaccinated patient who admitted through emergency department with COVID positive test on 09/19/21.  Patients respiratory status continued to decline, he required CCU admission high flow oxygen, and subsquently BiPAP.  Medical team reviewed ongoing respiratory decline and grave status with patient and family who declined intubation.  Patient moved to comfort care and died on 10/02/21."
	"1759418-1"	"1759418-1"	"RESPIRATORY FAILURE"	"10038695"	"65-79 years"	"65-79"	"Fully COVID vaccinated patient who admitted through emergency department with COVID positive test on 09/19/21.  Patients respiratory status continued to decline, he required CCU admission high flow oxygen, and subsquently BiPAP.  Medical team reviewed ongoing respiratory decline and grave status with patient and family who declined intubation.  Patient moved to comfort care and died on 10/02/21."
	"1759418-1"	"1759418-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Fully COVID vaccinated patient who admitted through emergency department with COVID positive test on 09/19/21.  Patients respiratory status continued to decline, he required CCU admission high flow oxygen, and subsquently BiPAP.  Medical team reviewed ongoing respiratory decline and grave status with patient and family who declined intubation.  Patient moved to comfort care and died on 10/02/21."
	"1759420-1"	"1759420-1"	"CHEMOTHERAPY"	"10061758"	"65-79 years"	"65-79"	"Pt had a history of right lower lobe small cell lung cancer and emphysema. He reports a feeling of fatigue and loss of appetite. He is still receiving chemotherapy. He was found to be COVID positive."
	"1759420-1"	"1759420-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Pt had a history of right lower lobe small cell lung cancer and emphysema. He reports a feeling of fatigue and loss of appetite. He is still receiving chemotherapy. He was found to be COVID positive."
	"1759420-1"	"1759420-1"	"DECREASED APPETITE"	"10061428"	"65-79 years"	"65-79"	"Pt had a history of right lower lobe small cell lung cancer and emphysema. He reports a feeling of fatigue and loss of appetite. He is still receiving chemotherapy. He was found to be COVID positive."
	"1759420-1"	"1759420-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"Pt had a history of right lower lobe small cell lung cancer and emphysema. He reports a feeling of fatigue and loss of appetite. He is still receiving chemotherapy. He was found to be COVID positive."
	"1759420-1"	"1759420-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Pt had a history of right lower lobe small cell lung cancer and emphysema. He reports a feeling of fatigue and loss of appetite. He is still receiving chemotherapy. He was found to be COVID positive."
	"1759504-1"	"1759504-1"	"ABDOMINAL PAIN"	"10000081"	"65-79 years"	"65-79"	"Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17.  She had symptoms for 2 weeks prior to admission.  The patient required non-rebreather while in the emergency department.  CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease.  CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process.  Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care.  The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula.  Her diarrhea and abdominal pain improved without intervention.  IV vancomycin was started as her sputum culture grew Staph aureus.  IV Lasix was administered.  The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease.  Goals of care were discussed with the patient by this provider.  The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure.  The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather.  Comfort measures were initiated after discussion with the patient and her son.  The patient passed away 09/26/2021 at 11:40 with family at bedside."
	"1759504-1"	"1759504-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17.  She had symptoms for 2 weeks prior to admission.  The patient required non-rebreather while in the emergency department.  CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease.  CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process.  Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care.  The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula.  Her diarrhea and abdominal pain improved without intervention.  IV vancomycin was started as her sputum culture grew Staph aureus.  IV Lasix was administered.  The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease.  Goals of care were discussed with the patient by this provider.  The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure.  The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather.  Comfort measures were initiated after discussion with the patient and her son.  The patient passed away 09/26/2021 at 11:40 with family at bedside."
	"1759504-1"	"1759504-1"	"ANGIOGRAM PULMONARY ABNORMAL"	"10002441"	"65-79 years"	"65-79"	"Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17.  She had symptoms for 2 weeks prior to admission.  The patient required non-rebreather while in the emergency department.  CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease.  CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process.  Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care.  The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula.  Her diarrhea and abdominal pain improved without intervention.  IV vancomycin was started as her sputum culture grew Staph aureus.  IV Lasix was administered.  The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease.  Goals of care were discussed with the patient by this provider.  The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure.  The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather.  Comfort measures were initiated after discussion with the patient and her son.  The patient passed away 09/26/2021 at 11:40 with family at bedside."
	"1759504-1"	"1759504-1"	"COMPUTERISED TOMOGRAM ABDOMEN ABNORMAL"	"10057798"	"65-79 years"	"65-79"	"Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17.  She had symptoms for 2 weeks prior to admission.  The patient required non-rebreather while in the emergency department.  CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease.  CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process.  Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care.  The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula.  Her diarrhea and abdominal pain improved without intervention.  IV vancomycin was started as her sputum culture grew Staph aureus.  IV Lasix was administered.  The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease.  Goals of care were discussed with the patient by this provider.  The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure.  The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather.  Comfort measures were initiated after discussion with the patient and her son.  The patient passed away 09/26/2021 at 11:40 with family at bedside."
	"1759504-1"	"1759504-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17.  She had symptoms for 2 weeks prior to admission.  The patient required non-rebreather while in the emergency department.  CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease.  CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process.  Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care.  The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula.  Her diarrhea and abdominal pain improved without intervention.  IV vancomycin was started as her sputum culture grew Staph aureus.  IV Lasix was administered.  The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease.  Goals of care were discussed with the patient by this provider.  The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure.  The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather.  Comfort measures were initiated after discussion with the patient and her son.  The patient passed away 09/26/2021 at 11:40 with family at bedside."
	"1759504-1"	"1759504-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17.  She had symptoms for 2 weeks prior to admission.  The patient required non-rebreather while in the emergency department.  CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease.  CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process.  Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care.  The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula.  Her diarrhea and abdominal pain improved without intervention.  IV vancomycin was started as her sputum culture grew Staph aureus.  IV Lasix was administered.  The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease.  Goals of care were discussed with the patient by this provider.  The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure.  The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather.  Comfort measures were initiated after discussion with the patient and her son.  The patient passed away 09/26/2021 at 11:40 with family at bedside."
	"1759504-1"	"1759504-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17.  She had symptoms for 2 weeks prior to admission.  The patient required non-rebreather while in the emergency department.  CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease.  CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process.  Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care.  The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula.  Her diarrhea and abdominal pain improved without intervention.  IV vancomycin was started as her sputum culture grew Staph aureus.  IV Lasix was administered.  The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease.  Goals of care were discussed with the patient by this provider.  The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure.  The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather.  Comfort measures were initiated after discussion with the patient and her son.  The patient passed away 09/26/2021 at 11:40 with family at bedside."
	"1759504-1"	"1759504-1"	"DIARRHOEA"	"10012735"	"65-79 years"	"65-79"	"Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17.  She had symptoms for 2 weeks prior to admission.  The patient required non-rebreather while in the emergency department.  CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease.  CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process.  Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care.  The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula.  Her diarrhea and abdominal pain improved without intervention.  IV vancomycin was started as her sputum culture grew Staph aureus.  IV Lasix was administered.  The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease.  Goals of care were discussed with the patient by this provider.  The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure.  The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather.  Comfort measures were initiated after discussion with the patient and her son.  The patient passed away 09/26/2021 at 11:40 with family at bedside."
	"1759504-1"	"1759504-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17.  She had symptoms for 2 weeks prior to admission.  The patient required non-rebreather while in the emergency department.  CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease.  CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process.  Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care.  The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula.  Her diarrhea and abdominal pain improved without intervention.  IV vancomycin was started as her sputum culture grew Staph aureus.  IV Lasix was administered.  The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease.  Goals of care were discussed with the patient by this provider.  The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure.  The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather.  Comfort measures were initiated after discussion with the patient and her son.  The patient passed away 09/26/2021 at 11:40 with family at bedside."
	"1759504-1"	"1759504-1"	"HAEMOPTYSIS"	"10018964"	"65-79 years"	"65-79"	"Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17.  She had symptoms for 2 weeks prior to admission.  The patient required non-rebreather while in the emergency department.  CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease.  CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process.  Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care.  The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula.  Her diarrhea and abdominal pain improved without intervention.  IV vancomycin was started as her sputum culture grew Staph aureus.  IV Lasix was administered.  The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease.  Goals of care were discussed with the patient by this provider.  The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure.  The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather.  Comfort measures were initiated after discussion with the patient and her son.  The patient passed away 09/26/2021 at 11:40 with family at bedside."
	"1759504-1"	"1759504-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17.  She had symptoms for 2 weeks prior to admission.  The patient required non-rebreather while in the emergency department.  CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease.  CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process.  Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care.  The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula.  Her diarrhea and abdominal pain improved without intervention.  IV vancomycin was started as her sputum culture grew Staph aureus.  IV Lasix was administered.  The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease.  Goals of care were discussed with the patient by this provider.  The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure.  The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather.  Comfort measures were initiated after discussion with the patient and her son.  The patient passed away 09/26/2021 at 11:40 with family at bedside."
	"1759504-1"	"1759504-1"	"LUNG DISORDER"	"10025082"	"65-79 years"	"65-79"	"Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17.  She had symptoms for 2 weeks prior to admission.  The patient required non-rebreather while in the emergency department.  CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease.  CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process.  Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care.  The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula.  Her diarrhea and abdominal pain improved without intervention.  IV vancomycin was started as her sputum culture grew Staph aureus.  IV Lasix was administered.  The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease.  Goals of care were discussed with the patient by this provider.  The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure.  The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather.  Comfort measures were initiated after discussion with the patient and her son.  The patient passed away 09/26/2021 at 11:40 with family at bedside."
	"1759504-1"	"1759504-1"	"PANCREATIC ATROPHY"	"10033603"	"65-79 years"	"65-79"	"Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17.  She had symptoms for 2 weeks prior to admission.  The patient required non-rebreather while in the emergency department.  CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease.  CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process.  Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care.  The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula.  Her diarrhea and abdominal pain improved without intervention.  IV vancomycin was started as her sputum culture grew Staph aureus.  IV Lasix was administered.  The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease.  Goals of care were discussed with the patient by this provider.  The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure.  The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather.  Comfort measures were initiated after discussion with the patient and her son.  The patient passed away 09/26/2021 at 11:40 with family at bedside."
	"1759504-1"	"1759504-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17.  She had symptoms for 2 weeks prior to admission.  The patient required non-rebreather while in the emergency department.  CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease.  CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process.  Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care.  The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula.  Her diarrhea and abdominal pain improved without intervention.  IV vancomycin was started as her sputum culture grew Staph aureus.  IV Lasix was administered.  The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease.  Goals of care were discussed with the patient by this provider.  The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure.  The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather.  Comfort measures were initiated after discussion with the patient and her son.  The patient passed away 09/26/2021 at 11:40 with family at bedside."
	"1759504-1"	"1759504-1"	"SPUTUM CULTURE POSITIVE"	"10051612"	"65-79 years"	"65-79"	"Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17.  She had symptoms for 2 weeks prior to admission.  The patient required non-rebreather while in the emergency department.  CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease.  CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process.  Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care.  The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula.  Her diarrhea and abdominal pain improved without intervention.  IV vancomycin was started as her sputum culture grew Staph aureus.  IV Lasix was administered.  The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease.  Goals of care were discussed with the patient by this provider.  The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure.  The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather.  Comfort measures were initiated after discussion with the patient and her son.  The patient passed away 09/26/2021 at 11:40 with family at bedside."
	"1759504-1"	"1759504-1"	"STAPHYLOCOCCAL INFECTION"	"10058080"	"65-79 years"	"65-79"	"Hospitalized 09/23/2021; COVID-19 positive 09/17/2021; fully vaccinated  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01] Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] COVID-19 [U07.1]   HOSPITAL COURSE: 73-year-old female with history of chronic respiratory failure on 3-4 L of oxygen at baseline, chronic obstructive pulmonary disease, previous colorectal cancer, OSA, and aortic stenosis who presented with worsening dyspnea, hypoxia, hemoptysis, abdominal pain, and diarrhea after being diagnosed with COVID-19 9-17.  She had symptoms for 2 weeks prior to admission.  The patient required non-rebreather while in the emergency department.  CTA was negative for PE, but showed diffuse bilateral peripheral airspace disease.  CT of the abdomen and pelvis showed an atrophic pancreas, but no acute process.  Steroids were started in the emergency department and the patient was admitted to the hospitalist service for further continuation of care.  The patient's oxygen requirement worsened to the point where she was on 100% via high-flow nasal cannula.  Her diarrhea and abdominal pain improved without intervention.  IV vancomycin was started as her sputum culture grew Staph aureus.  IV Lasix was administered.  The patient was discussed with pulmonology who reported that prognosis was poor in the setting of her pre-existing lung disease.  Goals of care were discussed with the patient by this provider.  The patient was clear that she would not want intubation and mechanical ventilation in the case of worsening respiratory failure.  The patient desaturated overnight 9-25 the and was hypoxic despite high-flow nasal cannula and non-rebreather.  Comfort measures were initiated after discussion with the patient and her son.  The patient passed away 09/26/2021 at 11:40 with family at bedside."
	"1759634-1"	"1759634-1"	"ACQUIRED DIAPHRAGMATIC EVENTRATION"	"10059185"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"ADULT FAILURE TO THRIVE"	"10077257"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"BASOPHIL COUNT NORMAL"	"10004170"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"BASOPHIL PERCENTAGE"	"10059471"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"EOSINOPHIL COUNT NORMAL"	"10014946"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"EOSINOPHIL PERCENTAGE"	"10059464"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"HAEMATOCRIT DECREASED"	"10018838"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"HAEMOGLOBIN DECREASED"	"10018884"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"LUNG INFILTRATION"	"10025102"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"LYMPHOCYTE COUNT DECREASED"	"10025256"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"LYMPHOCYTE PERCENTAGE DECREASED"	"10052231"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"MEAN CELL HAEMOGLOBIN CONCENTRATION NORMAL"	"10026994"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"MEAN CELL HAEMOGLOBIN NORMAL"	"10026997"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"MEAN CELL VOLUME NORMAL"	"10027006"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"MEAN PLATELET VOLUME NORMAL"	"10055070"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"MONOCYTE COUNT NORMAL"	"10027882"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"MONOCYTE PERCENTAGE"	"10059473"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"NEUTROPHIL COUNT NORMAL"	"10029370"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"NEUTROPHIL PERCENTAGE INCREASED"	"10052224"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"PLATELET COUNT DECREASED"	"10035528"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"PREALBUMIN DECREASED"	"10048436"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"RED BLOOD CELL COUNT DECREASED"	"10038153"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759634-1"	"1759634-1"	"RED CELL DISTRIBUTION WIDTH INCREASED"	"10053920"	"65-79 years"	"65-79"	"Guest passed/expired within 10 days of dose #2 of COVID-19 vaccine series. Began transitioning on 9/27/21-- 5 days s/p Dose #2. Guest was a hospice resident prior to COVID-19 vaccine and overall was having  general decline prior to vaccination. Signed on to hospice on 8/6/21.  Had active diagnosis of adult failure to thrive and hx of gastric CA--declined PEG tube.  Only acute side effect 2 days s/p dose 2 noted was fatigue. No side side effects were reported with dose #1."
	"1759807-1"	"1759807-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient died suddenly at approximately 6AM on the following morning  of 9/28/2021 after receiving the vaccine on 9/27/2021.  Pt became acutely SOB and family called 911 for an ambulance but patient died before help could arrive.  Pt's wife unable to give much further history."
	"1759807-1"	"1759807-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient died suddenly at approximately 6AM on the following morning  of 9/28/2021 after receiving the vaccine on 9/27/2021.  Pt became acutely SOB and family called 911 for an ambulance but patient died before help could arrive.  Pt's wife unable to give much further history."
	"1761852-1"	"1761852-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 09/20/2021."
	"1762271-1"	"1762271-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"The patient was found dead on 28th September. The deceased seemed to have struggled to stand up and fell onto the floor. There was a great deal of blood. The medical investigator immediately declared this death to be natural causes and refused to file a Vaers report stating that it had been too long (6 months and 2 weeks) and she would only file one up to 6 months; or carry out an autopsy which was requested by the various next of kin who were contacted, stating the body wasn't 'fresh enough'. Communications suggest the death occurred on 20th of September on the evening that the deceased had attended (and lead) a Meeting."
	"1762271-1"	"1762271-1"	"FALL"	"10016173"	"65-79 years"	"65-79"	"The patient was found dead on 28th September. The deceased seemed to have struggled to stand up and fell onto the floor. There was a great deal of blood. The medical investigator immediately declared this death to be natural causes and refused to file a Vaers report stating that it had been too long (6 months and 2 weeks) and she would only file one up to 6 months; or carry out an autopsy which was requested by the various next of kin who were contacted, stating the body wasn't 'fresh enough'. Communications suggest the death occurred on 20th of September on the evening that the deceased had attended (and lead) a Meeting."
	"1762271-1"	"1762271-1"	"HAEMORRHAGE"	"10055798"	"65-79 years"	"65-79"	"The patient was found dead on 28th September. The deceased seemed to have struggled to stand up and fell onto the floor. There was a great deal of blood. The medical investigator immediately declared this death to be natural causes and refused to file a Vaers report stating that it had been too long (6 months and 2 weeks) and she would only file one up to 6 months; or carry out an autopsy which was requested by the various next of kin who were contacted, stating the body wasn't 'fresh enough'. Communications suggest the death occurred on 20th of September on the evening that the deceased had attended (and lead) a Meeting."
	"1762271-1"	"1762271-1"	"INSOMNIA"	"10022437"	"65-79 years"	"65-79"	"The patient was found dead on 28th September. The deceased seemed to have struggled to stand up and fell onto the floor. There was a great deal of blood. The medical investigator immediately declared this death to be natural causes and refused to file a Vaers report stating that it had been too long (6 months and 2 weeks) and she would only file one up to 6 months; or carry out an autopsy which was requested by the various next of kin who were contacted, stating the body wasn't 'fresh enough'. Communications suggest the death occurred on 20th of September on the evening that the deceased had attended (and lead) a Meeting."
	"1765475-1"	"1765475-1"	"ABDOMINAL PAIN"	"10000081"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"BIOPSY LIVER"	"10004791"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"COLONOSCOPY"	"10010007"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"COMPUTERISED TOMOGRAM ABDOMEN ABNORMAL"	"10057798"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"INTESTINAL PERFORATION"	"10022694"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"LAPAROTOMY"	"10023696"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"LEUKOCYTOSIS"	"10024378"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"MASS"	"10026865"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"METASTATIC SQUAMOUS CELL CARCINOMA"	"10063569"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"NEUROENDOCRINE TUMOUR"	"10052399"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"OESOPHAGOGASTRODUODENOSCOPY"	"10053057"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765475-1"	"1765475-1"	"SEPSIS"	"10040047"	"65-79 years"	"65-79"	"Deceased (10.4.21);  Hospitalized (9.14.21);  COVID-19 positive (9.29.21);  fully vaccinated    Admission Date: 9/14/2021 Date of Death: 10/4/21 Time of Death:  6:56 AM Preliminary Cause of Death: Hypoxia DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Perforated abdominal viscus  Bowel perforation    a 68 y.o. female with past medical history significant for Crohn's disease on immunosuppressive therapy, history of stroke, and PAD who presented to the emergency department with severe abdominal pain.  CT concerning for bowel perforation and Colorectal took patient for urgent laparotomy and was treated with broad spectrum antibiotics and antifungals.  CT also with concern for liver metastasis and biopsy done in the OR showing metastatic neuroendocrine tumor.  Workup further showed a cardiac mass which was biopsied via RHC showing metastatic SCC indicating patient having two primary metastatic diseases.  Patient continued to decline and developed dyspnea; unfortunately she tested positive for COVID19.  Patient ultimately wished to be made comfort care and so hospice was consulted and comfort care orders initiated.  Medicine service took over care to facilitate this on 10/2.  Patient expired on 10/4/2021 at 6:56am."
	"1765535-1"	"1765535-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"Breakthrough COVID-19  infection.  Admitted for painful swallowing.  Progressed to shortness of breath and difficulty breathing.   History of esophageal cancer with recent start of chemo and radiation.  Required intubation and ventilator support.  Developed acute kidney injury, and goal changed to comfort measures."
	"1765535-1"	"1765535-1"	"CHEMOTHERAPY"	"10061758"	"65-79 years"	"65-79"	"Breakthrough COVID-19  infection.  Admitted for painful swallowing.  Progressed to shortness of breath and difficulty breathing.   History of esophageal cancer with recent start of chemo and radiation.  Required intubation and ventilator support.  Developed acute kidney injury, and goal changed to comfort measures."
	"1765535-1"	"1765535-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Breakthrough COVID-19  infection.  Admitted for painful swallowing.  Progressed to shortness of breath and difficulty breathing.   History of esophageal cancer with recent start of chemo and radiation.  Required intubation and ventilator support.  Developed acute kidney injury, and goal changed to comfort measures."
	"1765535-1"	"1765535-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Breakthrough COVID-19  infection.  Admitted for painful swallowing.  Progressed to shortness of breath and difficulty breathing.   History of esophageal cancer with recent start of chemo and radiation.  Required intubation and ventilator support.  Developed acute kidney injury, and goal changed to comfort measures."
	"1765535-1"	"1765535-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Breakthrough COVID-19  infection.  Admitted for painful swallowing.  Progressed to shortness of breath and difficulty breathing.   History of esophageal cancer with recent start of chemo and radiation.  Required intubation and ventilator support.  Developed acute kidney injury, and goal changed to comfort measures."
	"1765535-1"	"1765535-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Breakthrough COVID-19  infection.  Admitted for painful swallowing.  Progressed to shortness of breath and difficulty breathing.   History of esophageal cancer with recent start of chemo and radiation.  Required intubation and ventilator support.  Developed acute kidney injury, and goal changed to comfort measures."
	"1765535-1"	"1765535-1"	"ODYNOPHAGIA"	"10030094"	"65-79 years"	"65-79"	"Breakthrough COVID-19  infection.  Admitted for painful swallowing.  Progressed to shortness of breath and difficulty breathing.   History of esophageal cancer with recent start of chemo and radiation.  Required intubation and ventilator support.  Developed acute kidney injury, and goal changed to comfort measures."
	"1765535-1"	"1765535-1"	"RADIOTHERAPY"	"10037794"	"65-79 years"	"65-79"	"Breakthrough COVID-19  infection.  Admitted for painful swallowing.  Progressed to shortness of breath and difficulty breathing.   History of esophageal cancer with recent start of chemo and radiation.  Required intubation and ventilator support.  Developed acute kidney injury, and goal changed to comfort measures."
	"1765535-1"	"1765535-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"Breakthrough COVID-19  infection.  Admitted for painful swallowing.  Progressed to shortness of breath and difficulty breathing.   History of esophageal cancer with recent start of chemo and radiation.  Required intubation and ventilator support.  Developed acute kidney injury, and goal changed to comfort measures."
	"1765690-1"	"1765690-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"suspect patient death based on timing  Patient was seen on 3/31 for lumbar back pain with leg pain. had follow up visit scheduled with regular PCP within a few days.  had covid shot the next day. Then we noted he missed his appointment follow up with pcp and were told he had passed. noted his covid shot was the next day. sounds like he may have been found at home expired."
	"1768856-1"	"1768856-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"PATIENT DIED FROM COVID 19 AFTER BEING FULLY VACCINATED"
	"1768856-1"	"1768856-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"PATIENT DIED FROM COVID 19 AFTER BEING FULLY VACCINATED"
	"1768856-1"	"1768856-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"PATIENT DIED FROM COVID 19 AFTER BEING FULLY VACCINATED"
	"1770624-1"	"1770624-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death; This is a spontaneous report from a contactable other healthcare professional (HCP). A 67-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via unspecified route of administration in right arm on 27May2021 at 09:00 as single dose for COVID-19 immunisation. The relevant medical history included atherosclerosis from unspecified date. Concomitant medications included rosuvastatin calcium (CRESTOR). No other vaccine in four weeks. The patient experienced death on 07Jun2021 at 04:45. No treatment received for the events. No covid prior vaccination and no covid tested post vaccination. The patient died on 07Jun2021. It was unknown if an autopsy was performed. The outcome of the event was fatal.  The Lot number for the vaccine [BNT162B2] was not provided and will be requested during Follow-up.; Sender's Comments: The information currently provided is too limited to make a meaningful medical assessment. However, per company causality assessment guidance, the event of death with unknown cause is assessed as related until the cause of death is clarified. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to RAs, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Death"
	"1776938-1"	"1776938-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"COVID PCR +9/23/21.  Admitted for shortness of breath on Bi-pap."
	"1776938-1"	"1776938-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"COVID PCR +9/23/21.  Admitted for shortness of breath on Bi-pap."
	"1776938-1"	"1776938-1"	"POSITIVE AIRWAY PRESSURE THERAPY"	"10086397"	"65-79 years"	"65-79"	"COVID PCR +9/23/21.  Admitted for shortness of breath on Bi-pap."
	"1776938-1"	"1776938-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"COVID PCR +9/23/21.  Admitted for shortness of breath on Bi-pap."
	"1777314-1"	"1777314-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient did well with the first two doses, received the booster and two hours after he passed away.  According to the wife, he was alright in the two hour time frame post vaccination. He went shopping and showed no signs of anaphylaxis or intolerance."
	"1777314-1"	"1777314-1"	"NO REACTION ON PREVIOUS EXPOSURE TO DRUG"	"10052053"	"65-79 years"	"65-79"	"Patient did well with the first two doses, received the booster and two hours after he passed away.  According to the wife, he was alright in the two hour time frame post vaccination. He went shopping and showed no signs of anaphylaxis or intolerance."
	"1782307-1"	"1782307-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"BRADYCARDIA"	"10006093"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"BRAIN COMPRESSION"	"10006112"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"BRAIN OEDEMA"	"10048962"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"CEREBELLAR STROKE"	"10079062"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"CEREBRAL MASS EFFECT"	"10067086"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"COMPUTERISED TOMOGRAM HEAD ABNORMAL"	"10072168"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"COMPUTERISED TOMOGRAM THORAX ABNORMAL"	"10057799"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"FIBRIN D DIMER INCREASED"	"10016581"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"INFLUENZA A VIRUS TEST"	"10070416"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"INFLUENZA B VIRUS TEST"	"10071544"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"ISCHAEMIC STROKE"	"10061256"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"LATERAL MEDULLARY SYNDROME"	"10024033"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"NEUROLOGICAL EXAMINATION ABNORMAL"	"10056832"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"POSITIVE AIRWAY PRESSURE THERAPY"	"10086397"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"ULTRASOUND DOPPLER NORMAL"	"10045414"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782307-1"	"1782307-1"	"VERTEBRAL ARTERY OCCLUSION"	"10048965"	"65-79 years"	"65-79"	"transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION   Stroke    HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion.      Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin).    On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness.   He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone.  Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter.   CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia.  Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles.   He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000.  Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA.  There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management.   His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury.    Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm."
	"1782821-1"	"1782821-1"	"CYANOSIS"	"10011703"	"65-79 years"	"65-79"	"Presented to hospital after being unresponsive at home.  Patient began having upper respiratory symptoms on the Sunday prior to admission with frontal sinus pressure. Began having diarrhea the day prior to admission.  Day of admission patient was found to be nauseous, hot, profusely sweating and short of breath on the toilet. While on the toilet patient went unresponsive, slumped over, lips turned blue and EMS was called. Patient was intubated upon admission to the ER."
	"1782821-1"	"1782821-1"	"DIARRHOEA"	"10012735"	"65-79 years"	"65-79"	"Presented to hospital after being unresponsive at home.  Patient began having upper respiratory symptoms on the Sunday prior to admission with frontal sinus pressure. Began having diarrhea the day prior to admission.  Day of admission patient was found to be nauseous, hot, profusely sweating and short of breath on the toilet. While on the toilet patient went unresponsive, slumped over, lips turned blue and EMS was called. Patient was intubated upon admission to the ER."
	"1782821-1"	"1782821-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Presented to hospital after being unresponsive at home.  Patient began having upper respiratory symptoms on the Sunday prior to admission with frontal sinus pressure. Began having diarrhea the day prior to admission.  Day of admission patient was found to be nauseous, hot, profusely sweating and short of breath on the toilet. While on the toilet patient went unresponsive, slumped over, lips turned blue and EMS was called. Patient was intubated upon admission to the ER."
	"1782821-1"	"1782821-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Presented to hospital after being unresponsive at home.  Patient began having upper respiratory symptoms on the Sunday prior to admission with frontal sinus pressure. Began having diarrhea the day prior to admission.  Day of admission patient was found to be nauseous, hot, profusely sweating and short of breath on the toilet. While on the toilet patient went unresponsive, slumped over, lips turned blue and EMS was called. Patient was intubated upon admission to the ER."
	"1782821-1"	"1782821-1"	"FEELING HOT"	"10016334"	"65-79 years"	"65-79"	"Presented to hospital after being unresponsive at home.  Patient began having upper respiratory symptoms on the Sunday prior to admission with frontal sinus pressure. Began having diarrhea the day prior to admission.  Day of admission patient was found to be nauseous, hot, profusely sweating and short of breath on the toilet. While on the toilet patient went unresponsive, slumped over, lips turned blue and EMS was called. Patient was intubated upon admission to the ER."
	"1782821-1"	"1782821-1"	"HYPERHIDROSIS"	"10020642"	"65-79 years"	"65-79"	"Presented to hospital after being unresponsive at home.  Patient began having upper respiratory symptoms on the Sunday prior to admission with frontal sinus pressure. Began having diarrhea the day prior to admission.  Day of admission patient was found to be nauseous, hot, profusely sweating and short of breath on the toilet. While on the toilet patient went unresponsive, slumped over, lips turned blue and EMS was called. Patient was intubated upon admission to the ER."
	"1782821-1"	"1782821-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"Presented to hospital after being unresponsive at home.  Patient began having upper respiratory symptoms on the Sunday prior to admission with frontal sinus pressure. Began having diarrhea the day prior to admission.  Day of admission patient was found to be nauseous, hot, profusely sweating and short of breath on the toilet. While on the toilet patient went unresponsive, slumped over, lips turned blue and EMS was called. Patient was intubated upon admission to the ER."
	"1782821-1"	"1782821-1"	"PARANASAL SINUS DISCOMFORT"	"10052438"	"65-79 years"	"65-79"	"Presented to hospital after being unresponsive at home.  Patient began having upper respiratory symptoms on the Sunday prior to admission with frontal sinus pressure. Began having diarrhea the day prior to admission.  Day of admission patient was found to be nauseous, hot, profusely sweating and short of breath on the toilet. While on the toilet patient went unresponsive, slumped over, lips turned blue and EMS was called. Patient was intubated upon admission to the ER."
	"1782821-1"	"1782821-1"	"POSTURE ABNORMAL"	"10036436"	"65-79 years"	"65-79"	"Presented to hospital after being unresponsive at home.  Patient began having upper respiratory symptoms on the Sunday prior to admission with frontal sinus pressure. Began having diarrhea the day prior to admission.  Day of admission patient was found to be nauseous, hot, profusely sweating and short of breath on the toilet. While on the toilet patient went unresponsive, slumped over, lips turned blue and EMS was called. Patient was intubated upon admission to the ER."
	"1782821-1"	"1782821-1"	"RESPIRATORY SYMPTOM"	"10075535"	"65-79 years"	"65-79"	"Presented to hospital after being unresponsive at home.  Patient began having upper respiratory symptoms on the Sunday prior to admission with frontal sinus pressure. Began having diarrhea the day prior to admission.  Day of admission patient was found to be nauseous, hot, profusely sweating and short of breath on the toilet. While on the toilet patient went unresponsive, slumped over, lips turned blue and EMS was called. Patient was intubated upon admission to the ER."
	"1782821-1"	"1782821-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"Presented to hospital after being unresponsive at home.  Patient began having upper respiratory symptoms on the Sunday prior to admission with frontal sinus pressure. Began having diarrhea the day prior to admission.  Day of admission patient was found to be nauseous, hot, profusely sweating and short of breath on the toilet. While on the toilet patient went unresponsive, slumped over, lips turned blue and EMS was called. Patient was intubated upon admission to the ER."
	"1785258-1"	"1785258-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Symptom onset was 7-13-2021. Symptoms included fever, cough, shortness of breath, congestion, diarrhea, headache, fatigue, myalgia, ear infection, UTI. Patient was hospitalized from 7-28-21 through 8-15-2021. She passed away on 8-15-2021."
	"1785258-1"	"1785258-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Symptom onset was 7-13-2021. Symptoms included fever, cough, shortness of breath, congestion, diarrhea, headache, fatigue, myalgia, ear infection, UTI. Patient was hospitalized from 7-28-21 through 8-15-2021. She passed away on 8-15-2021."
	"1785258-1"	"1785258-1"	"DIARRHOEA"	"10012735"	"65-79 years"	"65-79"	"Symptom onset was 7-13-2021. Symptoms included fever, cough, shortness of breath, congestion, diarrhea, headache, fatigue, myalgia, ear infection, UTI. Patient was hospitalized from 7-28-21 through 8-15-2021. She passed away on 8-15-2021."
	"1785258-1"	"1785258-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Symptom onset was 7-13-2021. Symptoms included fever, cough, shortness of breath, congestion, diarrhea, headache, fatigue, myalgia, ear infection, UTI. Patient was hospitalized from 7-28-21 through 8-15-2021. She passed away on 8-15-2021."
	"1785258-1"	"1785258-1"	"EAR INFECTION"	"10014011"	"65-79 years"	"65-79"	"Symptom onset was 7-13-2021. Symptoms included fever, cough, shortness of breath, congestion, diarrhea, headache, fatigue, myalgia, ear infection, UTI. Patient was hospitalized from 7-28-21 through 8-15-2021. She passed away on 8-15-2021."
	"1785258-1"	"1785258-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"Symptom onset was 7-13-2021. Symptoms included fever, cough, shortness of breath, congestion, diarrhea, headache, fatigue, myalgia, ear infection, UTI. Patient was hospitalized from 7-28-21 through 8-15-2021. She passed away on 8-15-2021."
	"1785258-1"	"1785258-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	"Symptom onset was 7-13-2021. Symptoms included fever, cough, shortness of breath, congestion, diarrhea, headache, fatigue, myalgia, ear infection, UTI. Patient was hospitalized from 7-28-21 through 8-15-2021. She passed away on 8-15-2021."
	"1785258-1"	"1785258-1"	"MYALGIA"	"10028411"	"65-79 years"	"65-79"	"Symptom onset was 7-13-2021. Symptoms included fever, cough, shortness of breath, congestion, diarrhea, headache, fatigue, myalgia, ear infection, UTI. Patient was hospitalized from 7-28-21 through 8-15-2021. She passed away on 8-15-2021."
	"1785258-1"	"1785258-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"Symptom onset was 7-13-2021. Symptoms included fever, cough, shortness of breath, congestion, diarrhea, headache, fatigue, myalgia, ear infection, UTI. Patient was hospitalized from 7-28-21 through 8-15-2021. She passed away on 8-15-2021."
	"1785258-1"	"1785258-1"	"RESPIRATORY TRACT CONGESTION"	"10052251"	"65-79 years"	"65-79"	"Symptom onset was 7-13-2021. Symptoms included fever, cough, shortness of breath, congestion, diarrhea, headache, fatigue, myalgia, ear infection, UTI. Patient was hospitalized from 7-28-21 through 8-15-2021. She passed away on 8-15-2021."
	"1785258-1"	"1785258-1"	"URINARY TRACT INFECTION"	"10046571"	"65-79 years"	"65-79"	"Symptom onset was 7-13-2021. Symptoms included fever, cough, shortness of breath, congestion, diarrhea, headache, fatigue, myalgia, ear infection, UTI. Patient was hospitalized from 7-28-21 through 8-15-2021. She passed away on 8-15-2021."
	"1785515-1"	"1785515-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"HOSPITALIZED AND DECEASED AFTER BEING FULLY VACCINATED FOR COVID 19"
	"1785515-1"	"1785515-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"HOSPITALIZED AND DECEASED AFTER BEING FULLY VACCINATED FOR COVID 19"
	"1785515-1"	"1785515-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"HOSPITALIZED AND DECEASED AFTER BEING FULLY VACCINATED FOR COVID 19"
	"1794855-1"	"1794855-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"PATIENTS DEVELOPED COVID-19 PNEUMONIA ON 09/11/2021 THAT PROGRESSED TO PATIENT'S DEATH ON 10/09/2021 AFTER MANY DAYS IN HOSPITAL."
	"1794855-1"	"1794855-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"PATIENTS DEVELOPED COVID-19 PNEUMONIA ON 09/11/2021 THAT PROGRESSED TO PATIENT'S DEATH ON 10/09/2021 AFTER MANY DAYS IN HOSPITAL."
	"1795158-1"	"1795158-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"dose 1 moderna 2/4/2021 lot # 016M20A  patient has a cardiac arrest at home and died in the ED"
	"1795158-1"	"1795158-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"dose 1 moderna 2/4/2021 lot # 016M20A  patient has a cardiac arrest at home and died in the ED"
	"1801362-1"	"1801362-1"	"BRAIN INJURY"	"10067967"	"65-79 years"	"65-79"	"Vaccine dose 1 3/3/2021 Lot # EN6198 Pt died from anoxic brain injury 10/19/2021"
	"1801362-1"	"1801362-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Vaccine dose 1 3/3/2021 Lot # EN6198 Pt died from anoxic brain injury 10/19/2021"
	"1801362-1"	"1801362-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Vaccine dose 1 3/3/2021 Lot # EN6198 Pt died from anoxic brain injury 10/19/2021"
	"1804217-1"	"1804217-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"increase weakness, low oxygen saturation at 85% RA, fever, cough and congestion"
	"1804217-1"	"1804217-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"increase weakness, low oxygen saturation at 85% RA, fever, cough and congestion"
	"1804217-1"	"1804217-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"increase weakness, low oxygen saturation at 85% RA, fever, cough and congestion"
	"1804217-1"	"1804217-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"increase weakness, low oxygen saturation at 85% RA, fever, cough and congestion"
	"1804217-1"	"1804217-1"	"RESPIRATORY TRACT CONGESTION"	"10052251"	"65-79 years"	"65-79"	"increase weakness, low oxygen saturation at 85% RA, fever, cough and congestion"
	"1807978-1"	"1807978-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Covid vaccine #1 2/5/2021 Lot # N/A  Pt had cardiac arrest at home- died in the emergency room-not a covid related death"
	"1807978-1"	"1807978-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Covid vaccine #1 2/5/2021 Lot # N/A  Pt had cardiac arrest at home- died in the emergency room-not a covid related death"
	"1814974-1"	"1814974-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"AMS"
	"1814974-1"	"1814974-1"	"MENTAL STATUS CHANGES"	"10048294"	"65-79 years"	"65-79"	"AMS"
	"1814974-1"	"1814974-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"AMS"
	"1818410-1"	"1818410-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated    BRIEF OVERVIEW: Discharge Provider:  DO  Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY:   Hypoxia [R09.02]   HOSPITAL COURSE:   Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L  COVID19 infection. Improving  ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able.  Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement.  -To finish Decadron course at home. Lovenox at home  -pulmonary evaluated  Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated  Hospice note 10/21/2021: Reason for referral:  10/21/21: I spoke with patient's spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note"
	"1818410-1"	"1818410-1"	"ADENOCARCINOMA GASTRIC"	"10001150"	"65-79 years"	"65-79"	"Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated    BRIEF OVERVIEW: Discharge Provider:  DO  Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY:   Hypoxia [R09.02]   HOSPITAL COURSE:   Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L  COVID19 infection. Improving  ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able.  Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement.  -To finish Decadron course at home. Lovenox at home  -pulmonary evaluated  Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated  Hospice note 10/21/2021: Reason for referral:  10/21/21: I spoke with patient's spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note"
	"1818410-1"	"1818410-1"	"ANGIOGRAM PULMONARY NORMAL"	"10002442"	"65-79 years"	"65-79"	"Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated    BRIEF OVERVIEW: Discharge Provider:  DO  Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY:   Hypoxia [R09.02]   HOSPITAL COURSE:   Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L  COVID19 infection. Improving  ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able.  Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement.  -To finish Decadron course at home. Lovenox at home  -pulmonary evaluated  Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated  Hospice note 10/21/2021: Reason for referral:  10/21/21: I spoke with patient's spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note"
	"1818410-1"	"1818410-1"	"ANTICOAGULANT THERAPY"	"10053468"	"65-79 years"	"65-79"	"Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated    BRIEF OVERVIEW: Discharge Provider:  DO  Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY:   Hypoxia [R09.02]   HOSPITAL COURSE:   Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L  COVID19 infection. Improving  ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able.  Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement.  -To finish Decadron course at home. Lovenox at home  -pulmonary evaluated  Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated  Hospice note 10/21/2021: Reason for referral:  10/21/21: I spoke with patient's spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note"
	"1818410-1"	"1818410-1"	"CHRONIC LEFT VENTRICULAR FAILURE"	"10063083"	"65-79 years"	"65-79"	"Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated    BRIEF OVERVIEW: Discharge Provider:  DO  Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY:   Hypoxia [R09.02]   HOSPITAL COURSE:   Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L  COVID19 infection. Improving  ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able.  Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement.  -To finish Decadron course at home. Lovenox at home  -pulmonary evaluated  Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated  Hospice note 10/21/2021: Reason for referral:  10/21/21: I spoke with patient's spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note"
	"1818410-1"	"1818410-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated    BRIEF OVERVIEW: Discharge Provider:  DO  Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY:   Hypoxia [R09.02]   HOSPITAL COURSE:   Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L  COVID19 infection. Improving  ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able.  Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement.  -To finish Decadron course at home. Lovenox at home  -pulmonary evaluated  Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated  Hospice note 10/21/2021: Reason for referral:  10/21/21: I spoke with patient's spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note"
	"1818410-1"	"1818410-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated    BRIEF OVERVIEW: Discharge Provider:  DO  Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY:   Hypoxia [R09.02]   HOSPITAL COURSE:   Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L  COVID19 infection. Improving  ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able.  Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement.  -To finish Decadron course at home. Lovenox at home  -pulmonary evaluated  Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated  Hospice note 10/21/2021: Reason for referral:  10/21/21: I spoke with patient's spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note"
	"1818410-1"	"1818410-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated    BRIEF OVERVIEW: Discharge Provider:  DO  Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY:   Hypoxia [R09.02]   HOSPITAL COURSE:   Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L  COVID19 infection. Improving  ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able.  Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement.  -To finish Decadron course at home. Lovenox at home  -pulmonary evaluated  Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated  Hospice note 10/21/2021: Reason for referral:  10/21/21: I spoke with patient's spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note"
	"1818410-1"	"1818410-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated    BRIEF OVERVIEW: Discharge Provider:  DO  Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY:   Hypoxia [R09.02]   HOSPITAL COURSE:   Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L  COVID19 infection. Improving  ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able.  Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement.  -To finish Decadron course at home. Lovenox at home  -pulmonary evaluated  Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated  Hospice note 10/21/2021: Reason for referral:  10/21/21: I spoke with patient's spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note"
	"1818410-1"	"1818410-1"	"EJECTION FRACTION DECREASED"	"10050528"	"65-79 years"	"65-79"	"Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated    BRIEF OVERVIEW: Discharge Provider:  DO  Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY:   Hypoxia [R09.02]   HOSPITAL COURSE:   Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L  COVID19 infection. Improving  ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able.  Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement.  -To finish Decadron course at home. Lovenox at home  -pulmonary evaluated  Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated  Hospice note 10/21/2021: Reason for referral:  10/21/21: I spoke with patient's spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note"
	"1818410-1"	"1818410-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated    BRIEF OVERVIEW: Discharge Provider:  DO  Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY:   Hypoxia [R09.02]   HOSPITAL COURSE:   Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L  COVID19 infection. Improving  ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able.  Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement.  -To finish Decadron course at home. Lovenox at home  -pulmonary evaluated  Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated  Hospice note 10/21/2021: Reason for referral:  10/21/21: I spoke with patient's spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note"
	"1818410-1"	"1818410-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated    BRIEF OVERVIEW: Discharge Provider:  DO  Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY:   Hypoxia [R09.02]   HOSPITAL COURSE:   Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L  COVID19 infection. Improving  ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able.  Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement.  -To finish Decadron course at home. Lovenox at home  -pulmonary evaluated  Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated  Hospice note 10/21/2021: Reason for referral:  10/21/21: I spoke with patient's spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note"
	"1818410-1"	"1818410-1"	"ILLNESS"	"10080284"	"65-79 years"	"65-79"	"Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated    BRIEF OVERVIEW: Discharge Provider:  DO  Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY:   Hypoxia [R09.02]   HOSPITAL COURSE:   Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L  COVID19 infection. Improving  ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able.  Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement.  -To finish Decadron course at home. Lovenox at home  -pulmonary evaluated  Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated  Hospice note 10/21/2021: Reason for referral:  10/21/21: I spoke with patient's spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note"
	"1818410-1"	"1818410-1"	"INTERSTITIAL LUNG DISEASE"	"10022611"	"65-79 years"	"65-79"	"Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated    BRIEF OVERVIEW: Discharge Provider:  DO  Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY:   Hypoxia [R09.02]   HOSPITAL COURSE:   Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L  COVID19 infection. Improving  ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able.  Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement.  -To finish Decadron course at home. Lovenox at home  -pulmonary evaluated  Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated  Hospice note 10/21/2021: Reason for referral:  10/21/21: I spoke with patient's spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note"
	"1818410-1"	"1818410-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated    BRIEF OVERVIEW: Discharge Provider:  DO  Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY:   Hypoxia [R09.02]   HOSPITAL COURSE:   Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L  COVID19 infection. Improving  ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able.  Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement.  -To finish Decadron course at home. Lovenox at home  -pulmonary evaluated  Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated  Hospice note 10/21/2021: Reason for referral:  10/21/21: I spoke with patient's spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note"
	"1818558-1"	"1818558-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient died several hours after receiving first COVID-19 vaccine from Pfizer."
	"1821109-1"	"1821109-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"After receiving  the Moderna COVID-19 booster at 11:15am on 10/24/21, she felt normal until 10pm that evening.  The she was chilling slightly, headache and general body aches.  On 10/25/21, at around 10am, she became short of breath and experienced pain in her left side.  She measured her O2 and was a 94; after using some auxilary oxygen (her husband's machine) at 3 liters, she reached 97.  General malaise continued and at approximately 8pm, she suddenly collapsed and died."
	"1821109-1"	"1821109-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"After receiving  the Moderna COVID-19 booster at 11:15am on 10/24/21, she felt normal until 10pm that evening.  The she was chilling slightly, headache and general body aches.  On 10/25/21, at around 10am, she became short of breath and experienced pain in her left side.  She measured her O2 and was a 94; after using some auxilary oxygen (her husband's machine) at 3 liters, she reached 97.  General malaise continued and at approximately 8pm, she suddenly collapsed and died."
	"1821109-1"	"1821109-1"	"FEELING COLD"	"10016326"	"65-79 years"	"65-79"	"After receiving  the Moderna COVID-19 booster at 11:15am on 10/24/21, she felt normal until 10pm that evening.  The she was chilling slightly, headache and general body aches.  On 10/25/21, at around 10am, she became short of breath and experienced pain in her left side.  She measured her O2 and was a 94; after using some auxilary oxygen (her husband's machine) at 3 liters, she reached 97.  General malaise continued and at approximately 8pm, she suddenly collapsed and died."
	"1821109-1"	"1821109-1"	"FLANK PAIN"	"10016750"	"65-79 years"	"65-79"	"After receiving  the Moderna COVID-19 booster at 11:15am on 10/24/21, she felt normal until 10pm that evening.  The she was chilling slightly, headache and general body aches.  On 10/25/21, at around 10am, she became short of breath and experienced pain in her left side.  She measured her O2 and was a 94; after using some auxilary oxygen (her husband's machine) at 3 liters, she reached 97.  General malaise continued and at approximately 8pm, she suddenly collapsed and died."
	"1821109-1"	"1821109-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	"After receiving  the Moderna COVID-19 booster at 11:15am on 10/24/21, she felt normal until 10pm that evening.  The she was chilling slightly, headache and general body aches.  On 10/25/21, at around 10am, she became short of breath and experienced pain in her left side.  She measured her O2 and was a 94; after using some auxilary oxygen (her husband's machine) at 3 liters, she reached 97.  General malaise continued and at approximately 8pm, she suddenly collapsed and died."
	"1821109-1"	"1821109-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"After receiving  the Moderna COVID-19 booster at 11:15am on 10/24/21, she felt normal until 10pm that evening.  The she was chilling slightly, headache and general body aches.  On 10/25/21, at around 10am, she became short of breath and experienced pain in her left side.  She measured her O2 and was a 94; after using some auxilary oxygen (her husband's machine) at 3 liters, she reached 97.  General malaise continued and at approximately 8pm, she suddenly collapsed and died."
	"1821109-1"	"1821109-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	"After receiving  the Moderna COVID-19 booster at 11:15am on 10/24/21, she felt normal until 10pm that evening.  The she was chilling slightly, headache and general body aches.  On 10/25/21, at around 10am, she became short of breath and experienced pain in her left side.  She measured her O2 and was a 94; after using some auxilary oxygen (her husband's machine) at 3 liters, she reached 97.  General malaise continued and at approximately 8pm, she suddenly collapsed and died."
	"1821109-1"	"1821109-1"	"SYNCOPE"	"10042772"	"65-79 years"	"65-79"	"After receiving  the Moderna COVID-19 booster at 11:15am on 10/24/21, she felt normal until 10pm that evening.  The she was chilling slightly, headache and general body aches.  On 10/25/21, at around 10am, she became short of breath and experienced pain in her left side.  She measured her O2 and was a 94; after using some auxilary oxygen (her husband's machine) at 3 liters, she reached 97.  General malaise continued and at approximately 8pm, she suddenly collapsed and died."
	"1821117-1"	"1821117-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient diagnosed and hospitalized with COVID-19 while fully vaccinated."
	"1821160-1"	"1821160-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient diagnosed and hospitalized with COVID-19 while fully vaccinated."
	"1821320-1"	"1821320-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient diagnosed and hospitalized with COVID-19 while fully vaccinated."
	"1825226-1"	"1825226-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Pt presented to Emergency Room at local Medical Center on August 29, 2011 with complaints of not feeling right and fell at home.  The patient was diagnosed with COVID-19 infection, he was previously fully vaccinated on 2/19/2021 & 3/12/2021.  Patient completed Remdesivir and Decadron, patients oxygen requirements increased during hospitalization, requiring additional course of steroids.  Patient required CPAP during the Hospital Course.  After using the CPAP, the patient developed a facial abscess.  ENT did an incision and drainage.  The patient completed antibiotics. Patient was admitted to a Specialty Hospital.  to continue care.   On 10/27/2021 the patient met with the physician and family members and due to his significant decline, poor prognosis and increased oxygen needs, the patient chose to go comfort cares and expired on 10/27/2021 1835."
	"1825226-1"	"1825226-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt presented to Emergency Room at local Medical Center on August 29, 2011 with complaints of not feeling right and fell at home.  The patient was diagnosed with COVID-19 infection, he was previously fully vaccinated on 2/19/2021 & 3/12/2021.  Patient completed Remdesivir and Decadron, patients oxygen requirements increased during hospitalization, requiring additional course of steroids.  Patient required CPAP during the Hospital Course.  After using the CPAP, the patient developed a facial abscess.  ENT did an incision and drainage.  The patient completed antibiotics. Patient was admitted to a Specialty Hospital.  to continue care.   On 10/27/2021 the patient met with the physician and family members and due to his significant decline, poor prognosis and increased oxygen needs, the patient chose to go comfort cares and expired on 10/27/2021 1835."
	"1825226-1"	"1825226-1"	"FALL"	"10016173"	"65-79 years"	"65-79"	"Pt presented to Emergency Room at local Medical Center on August 29, 2011 with complaints of not feeling right and fell at home.  The patient was diagnosed with COVID-19 infection, he was previously fully vaccinated on 2/19/2021 & 3/12/2021.  Patient completed Remdesivir and Decadron, patients oxygen requirements increased during hospitalization, requiring additional course of steroids.  Patient required CPAP during the Hospital Course.  After using the CPAP, the patient developed a facial abscess.  ENT did an incision and drainage.  The patient completed antibiotics. Patient was admitted to a Specialty Hospital.  to continue care.   On 10/27/2021 the patient met with the physician and family members and due to his significant decline, poor prognosis and increased oxygen needs, the patient chose to go comfort cares and expired on 10/27/2021 1835."
	"1825226-1"	"1825226-1"	"FEELING ABNORMAL"	"10016322"	"65-79 years"	"65-79"	"Pt presented to Emergency Room at local Medical Center on August 29, 2011 with complaints of not feeling right and fell at home.  The patient was diagnosed with COVID-19 infection, he was previously fully vaccinated on 2/19/2021 & 3/12/2021.  Patient completed Remdesivir and Decadron, patients oxygen requirements increased during hospitalization, requiring additional course of steroids.  Patient required CPAP during the Hospital Course.  After using the CPAP, the patient developed a facial abscess.  ENT did an incision and drainage.  The patient completed antibiotics. Patient was admitted to a Specialty Hospital.  to continue care.   On 10/27/2021 the patient met with the physician and family members and due to his significant decline, poor prognosis and increased oxygen needs, the patient chose to go comfort cares and expired on 10/27/2021 1835."
	"1825226-1"	"1825226-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Pt presented to Emergency Room at local Medical Center on August 29, 2011 with complaints of not feeling right and fell at home.  The patient was diagnosed with COVID-19 infection, he was previously fully vaccinated on 2/19/2021 & 3/12/2021.  Patient completed Remdesivir and Decadron, patients oxygen requirements increased during hospitalization, requiring additional course of steroids.  Patient required CPAP during the Hospital Course.  After using the CPAP, the patient developed a facial abscess.  ENT did an incision and drainage.  The patient completed antibiotics. Patient was admitted to a Specialty Hospital.  to continue care.   On 10/27/2021 the patient met with the physician and family members and due to his significant decline, poor prognosis and increased oxygen needs, the patient chose to go comfort cares and expired on 10/27/2021 1835."
	"1825226-1"	"1825226-1"	"INCISIONAL DRAINAGE"	"10052532"	"65-79 years"	"65-79"	"Pt presented to Emergency Room at local Medical Center on August 29, 2011 with complaints of not feeling right and fell at home.  The patient was diagnosed with COVID-19 infection, he was previously fully vaccinated on 2/19/2021 & 3/12/2021.  Patient completed Remdesivir and Decadron, patients oxygen requirements increased during hospitalization, requiring additional course of steroids.  Patient required CPAP during the Hospital Course.  After using the CPAP, the patient developed a facial abscess.  ENT did an incision and drainage.  The patient completed antibiotics. Patient was admitted to a Specialty Hospital.  to continue care.   On 10/27/2021 the patient met with the physician and family members and due to his significant decline, poor prognosis and increased oxygen needs, the patient chose to go comfort cares and expired on 10/27/2021 1835."
	"1825226-1"	"1825226-1"	"POSITIVE AIRWAY PRESSURE THERAPY"	"10086397"	"65-79 years"	"65-79"	"Pt presented to Emergency Room at local Medical Center on August 29, 2011 with complaints of not feeling right and fell at home.  The patient was diagnosed with COVID-19 infection, he was previously fully vaccinated on 2/19/2021 & 3/12/2021.  Patient completed Remdesivir and Decadron, patients oxygen requirements increased during hospitalization, requiring additional course of steroids.  Patient required CPAP during the Hospital Course.  After using the CPAP, the patient developed a facial abscess.  ENT did an incision and drainage.  The patient completed antibiotics. Patient was admitted to a Specialty Hospital.  to continue care.   On 10/27/2021 the patient met with the physician and family members and due to his significant decline, poor prognosis and increased oxygen needs, the patient chose to go comfort cares and expired on 10/27/2021 1835."
	"1825226-1"	"1825226-1"	"SUBCUTANEOUS ABSCESS"	"10042343"	"65-79 years"	"65-79"	"Pt presented to Emergency Room at local Medical Center on August 29, 2011 with complaints of not feeling right and fell at home.  The patient was diagnosed with COVID-19 infection, he was previously fully vaccinated on 2/19/2021 & 3/12/2021.  Patient completed Remdesivir and Decadron, patients oxygen requirements increased during hospitalization, requiring additional course of steroids.  Patient required CPAP during the Hospital Course.  After using the CPAP, the patient developed a facial abscess.  ENT did an incision and drainage.  The patient completed antibiotics. Patient was admitted to a Specialty Hospital.  to continue care.   On 10/27/2021 the patient met with the physician and family members and due to his significant decline, poor prognosis and increased oxygen needs, the patient chose to go comfort cares and expired on 10/27/2021 1835."
	"1825439-1"	"1825439-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Previously submitted data on this patient, E report #679858 submitting f/u information.  Pt expired 10/28/2021  PRINCIPAL DIAGNOSIS COVID-19 Infection   SECONDARY DIAGNOSES Principal Problem:   COVID-19 Infection Active Problems:   Pneumonia Due To COVID-19   Leukemia Lymphocytic Chronic Not Having Achieved Remission (HCC)   Acute Respiratory Failure With Hypoxia (HCC)   Leukemia Lymphocytic Chronic In Relapse (HCC)   Chronic Kidney Disease (CKD), Stage 3b Glomerular Filtration Rate (GFR) 30 To 44 (HCC)   Thrombocytopenia (HCC)   Depression Major Recurrent Partial Remission (HCC)   PreDiabetes   Hypertension Essential Primary   Hypogammaglobulinemia (HCC)   Decline Functional Status   Depression Major Recurrent (HCC)   Shortness Of Breath"
	"1825439-1"	"1825439-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Previously submitted data on this patient, E report #679858 submitting f/u information.  Pt expired 10/28/2021  PRINCIPAL DIAGNOSIS COVID-19 Infection   SECONDARY DIAGNOSES Principal Problem:   COVID-19 Infection Active Problems:   Pneumonia Due To COVID-19   Leukemia Lymphocytic Chronic Not Having Achieved Remission (HCC)   Acute Respiratory Failure With Hypoxia (HCC)   Leukemia Lymphocytic Chronic In Relapse (HCC)   Chronic Kidney Disease (CKD), Stage 3b Glomerular Filtration Rate (GFR) 30 To 44 (HCC)   Thrombocytopenia (HCC)   Depression Major Recurrent Partial Remission (HCC)   PreDiabetes   Hypertension Essential Primary   Hypogammaglobulinemia (HCC)   Decline Functional Status   Depression Major Recurrent (HCC)   Shortness Of Breath"
	"1825439-1"	"1825439-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Previously submitted data on this patient, E report #679858 submitting f/u information.  Pt expired 10/28/2021  PRINCIPAL DIAGNOSIS COVID-19 Infection   SECONDARY DIAGNOSES Principal Problem:   COVID-19 Infection Active Problems:   Pneumonia Due To COVID-19   Leukemia Lymphocytic Chronic Not Having Achieved Remission (HCC)   Acute Respiratory Failure With Hypoxia (HCC)   Leukemia Lymphocytic Chronic In Relapse (HCC)   Chronic Kidney Disease (CKD), Stage 3b Glomerular Filtration Rate (GFR) 30 To 44 (HCC)   Thrombocytopenia (HCC)   Depression Major Recurrent Partial Remission (HCC)   PreDiabetes   Hypertension Essential Primary   Hypogammaglobulinemia (HCC)   Decline Functional Status   Depression Major Recurrent (HCC)   Shortness Of Breath"
	"1825439-1"	"1825439-1"	"GLOMERULAR FILTRATION RATE DECREASED"	"10018358"	"65-79 years"	"65-79"	"Previously submitted data on this patient, E report #679858 submitting f/u information.  Pt expired 10/28/2021  PRINCIPAL DIAGNOSIS COVID-19 Infection   SECONDARY DIAGNOSES Principal Problem:   COVID-19 Infection Active Problems:   Pneumonia Due To COVID-19   Leukemia Lymphocytic Chronic Not Having Achieved Remission (HCC)   Acute Respiratory Failure With Hypoxia (HCC)   Leukemia Lymphocytic Chronic In Relapse (HCC)   Chronic Kidney Disease (CKD), Stage 3b Glomerular Filtration Rate (GFR) 30 To 44 (HCC)   Thrombocytopenia (HCC)   Depression Major Recurrent Partial Remission (HCC)   PreDiabetes   Hypertension Essential Primary   Hypogammaglobulinemia (HCC)   Decline Functional Status   Depression Major Recurrent (HCC)   Shortness Of Breath"
	"1828580-1"	"1828580-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient's symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient's condition continued to deteriorate and he was intubated on 9/24/2021. Patient's condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021."
	"1828580-1"	"1828580-1"	"BACTERIAL INFECTION"	"10060945"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient's symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient's condition continued to deteriorate and he was intubated on 9/24/2021. Patient's condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021."
	"1828580-1"	"1828580-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient's symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient's condition continued to deteriorate and he was intubated on 9/24/2021. Patient's condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021."
	"1828580-1"	"1828580-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient's symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient's condition continued to deteriorate and he was intubated on 9/24/2021. Patient's condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021."
	"1828580-1"	"1828580-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient's symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient's condition continued to deteriorate and he was intubated on 9/24/2021. Patient's condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021."
	"1828580-1"	"1828580-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient's symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient's condition continued to deteriorate and he was intubated on 9/24/2021. Patient's condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021."
	"1828580-1"	"1828580-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient's symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient's condition continued to deteriorate and he was intubated on 9/24/2021. Patient's condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021."
	"1828580-1"	"1828580-1"	"GASTROINTESTINAL HAEMORRHAGE"	"10017955"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient's symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient's condition continued to deteriorate and he was intubated on 9/24/2021. Patient's condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021."
	"1828580-1"	"1828580-1"	"HAEMOFILTRATION"	"10053090"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient's symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient's condition continued to deteriorate and he was intubated on 9/24/2021. Patient's condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021."
	"1828580-1"	"1828580-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient's symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient's condition continued to deteriorate and he was intubated on 9/24/2021. Patient's condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021."
	"1828580-1"	"1828580-1"	"LOSS OF CONSCIOUSNESS"	"10024855"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient's symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient's condition continued to deteriorate and he was intubated on 9/24/2021. Patient's condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021."
	"1828580-1"	"1828580-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient's symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient's condition continued to deteriorate and he was intubated on 9/24/2021. Patient's condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021."
	"1828580-1"	"1828580-1"	"PULSELESS ELECTRICAL ACTIVITY"	"10058151"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient's symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient's condition continued to deteriorate and he was intubated on 9/24/2021. Patient's condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021."
	"1828580-1"	"1828580-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient's symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient's condition continued to deteriorate and he was intubated on 9/24/2021. Patient's condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021."
	"1828580-1"	"1828580-1"	"SEPTIC SHOCK"	"10040070"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient's symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient's condition continued to deteriorate and he was intubated on 9/24/2021. Patient's condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021."
	"1828580-1"	"1828580-1"	"TOXIC ENCEPHALOPATHY"	"10044221"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient's symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient's condition continued to deteriorate and he was intubated on 9/24/2021. Patient's condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021."
	"1828858-1"	"1828858-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Feeling ill, became unresponsive and called 911   Full resuscitation efforts given, patient expired in the field"
	"1828858-1"	"1828858-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Feeling ill, became unresponsive and called 911   Full resuscitation efforts given, patient expired in the field"
	"1828858-1"	"1828858-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Feeling ill, became unresponsive and called 911   Full resuscitation efforts given, patient expired in the field"
	"1828858-1"	"1828858-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"Feeling ill, became unresponsive and called 911   Full resuscitation efforts given, patient expired in the field"
	"1828873-1"	"1828873-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Feeling ill, weakness - cardiac arrest  Full resusitation efforts, transported  to Hospital ED"
	"1828873-1"	"1828873-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Feeling ill, weakness - cardiac arrest  Full resusitation efforts, transported  to Hospital ED"
	"1828873-1"	"1828873-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Feeling ill, weakness - cardiac arrest  Full resusitation efforts, transported  to Hospital ED"
	"1828873-1"	"1828873-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Feeling ill, weakness - cardiac arrest  Full resusitation efforts, transported  to Hospital ED"
	"1829230-1"	"1829230-1"	"AORTIC VALVE REPLACEMENT"	"10002916"	"65-79 years"	"65-79"	"Patient expired 10/27/2021."
	"1829230-1"	"1829230-1"	"CARDIAC PACEMAKER INSERTION"	"10007598"	"65-79 years"	"65-79"	"Patient expired 10/27/2021."
	"1829230-1"	"1829230-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient expired 10/27/2021."
	"1829320-1"	"1829320-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"NECK PAIN AND DEHYDRATION"
	"1829320-1"	"1829320-1"	"DEHYDRATION"	"10012174"	"65-79 years"	"65-79"	"NECK PAIN AND DEHYDRATION"
	"1829320-1"	"1829320-1"	"NECK PAIN"	"10028836"	"65-79 years"	"65-79"	"NECK PAIN AND DEHYDRATION"
	"1829320-1"	"1829320-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"NECK PAIN AND DEHYDRATION"
	"1833084-1"	"1833084-1"	"ACTIVATED PARTIAL THROMBOPLASTIN TIME PROLONGED"	"10000636"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"ALANINE AMINOTRANSFERASE INCREASED"	"10001551"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"ANION GAP NORMAL"	"10002530"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"ANTICOAGULANT THERAPY"	"10053468"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"ASPARTATE AMINOTRANSFERASE INCREASED"	"10003481"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"ATRIAL FIBRILLATION"	"10003658"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"BASOPHIL PERCENTAGE DECREASED"	"10052219"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"BLOOD ALBUMIN DECREASED"	"10005287"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"BLOOD ALKALINE PHOSPHATASE NORMAL"	"10005310"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"BLOOD BILIRUBIN NORMAL"	"10005367"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"BLOOD CALCIUM DECREASED"	"10005395"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"BLOOD CHLORIDE INCREASED"	"10005420"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"BLOOD CREATININE INCREASED"	"10005483"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"BLOOD GLUCOSE ABNORMAL"	"10005554"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"BLOOD LACTATE DEHYDROGENASE INCREASED"	"10005630"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"BLOOD PHOSPHORUS DECREASED"	"10049471"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"BLOOD POTASSIUM INCREASED"	"10005725"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"BLOOD SODIUM NORMAL"	"10005804"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"BLOOD UREA INCREASED"	"10005851"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"BRAIN NATRIURETIC PEPTIDE INCREASED"	"10053405"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"CARBON DIOXIDE DECREASED"	"10007223"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"CARDIAC FAILURE CONGESTIVE"	"10007559"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"CHEST X-RAY"	"10008498"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"CHRONIC KIDNEY DISEASE"	"10064848"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"DIFFERENTIAL WHITE BLOOD CELL COUNT"	"10012784"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"EOSINOPHIL PERCENTAGE DECREASED"	"10052221"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"FULL BLOOD COUNT"	"10017411"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"GLOMERULAR FILTRATION RATE DECREASED"	"10018358"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"HAEMATOCRIT DECREASED"	"10018838"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"HAEMOGLOBIN DECREASED"	"10018884"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"LABORATORY TEST"	"10059938"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"LABORATORY TEST ABNORMAL"	"10023547"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"LYMPHOCYTE COUNT DECREASED"	"10025256"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"LYMPHOCYTE PERCENTAGE DECREASED"	"10052231"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"MEAN CELL HAEMOGLOBIN CONCENTRATION NORMAL"	"10026994"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"MEAN CELL HAEMOGLOBIN NORMAL"	"10026997"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"MEAN CELL VOLUME NORMAL"	"10027006"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"MEAN PLATELET VOLUME NORMAL"	"10055070"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"MONOCYTE COUNT"	"10027876"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"MONOCYTE PERCENTAGE"	"10059473"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"MYOCARDIAL INJURY"	"10085879"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"NEUTROPHIL COUNT"	"10029363"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"NEUTROPHIL PERCENTAGE INCREASED"	"10052224"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"PLATELET COUNT NORMAL"	"10035530"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"PROTEIN TOTAL DECREASED"	"10037014"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"RED BLOOD CELL COUNT DECREASED"	"10038153"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"RED CELL DISTRIBUTION WIDTH INCREASED"	"10053920"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"RENAL FAILURE"	"10038435"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"TROPONIN I INCREASED"	"10058268"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833084-1"	"1833084-1"	"WHITE BLOOD CELL COUNT NORMAL"	"10047944"	"65-79 years"	"65-79"	"8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19.  VSS, NAD.  Saturating well on 3 L nasal cannula.  Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,"
	"1833657-1"	"1833657-1"	"BALANCE DISORDER"	"10049848"	"65-79 years"	"65-79"	"4/27/21 visit to clinic: 74yr old female who has had off balance and leaning way to right and stumbling. This lasted short time.  By time sister got to view she was sitting in a chair. Some of these symptoms began 2 days before this visit and have been completely resolved since that time.   Patient has tried No medications.  7/9/21 clinic 75yr old female presents for referral to ortho for fracture of elbow and possible wrist.  Had fallen 6 days ago.  Was seen in ER and pout in posterior cast and told to see ortho when back here.  recommends for her to be seen by Specialist.  She may need a total elbow replacement.    9/12/21 ED Closed displaced fracture of medial epicondyle of right humerus, unspecified fracture morphology, initial encounter Acute  9/17/21 admit to nursing home H/O: CVA (cerebrovascular accident)   Dementia without behavioral disturbance, unspecified dementia type (HCC)   Cognitive safety issue     Plan: She will be admitted to nursing home on Tuesday, 9/21/2021.  We have asked her that the physical therapy would evaluate her for the best cane possible   10/29/21 Patient presents to ED via EMS from nursing home for diaphoresis, altered mental status.  She was 'found like this' by nursing just prior to arrival to ED.  Patient has prior history of CVA, recovered.  Staff believed she may be having 'another stroke'."
	"1833657-1"	"1833657-1"	"CAST APPLICATION"	"10050305"	"65-79 years"	"65-79"	"4/27/21 visit to clinic: 74yr old female who has had off balance and leaning way to right and stumbling. This lasted short time.  By time sister got to view she was sitting in a chair. Some of these symptoms began 2 days before this visit and have been completely resolved since that time.   Patient has tried No medications.  7/9/21 clinic 75yr old female presents for referral to ortho for fracture of elbow and possible wrist.  Had fallen 6 days ago.  Was seen in ER and pout in posterior cast and told to see ortho when back here.  recommends for her to be seen by Specialist.  She may need a total elbow replacement.    9/12/21 ED Closed displaced fracture of medial epicondyle of right humerus, unspecified fracture morphology, initial encounter Acute  9/17/21 admit to nursing home H/O: CVA (cerebrovascular accident)   Dementia without behavioral disturbance, unspecified dementia type (HCC)   Cognitive safety issue     Plan: She will be admitted to nursing home on Tuesday, 9/21/2021.  We have asked her that the physical therapy would evaluate her for the best cane possible   10/29/21 Patient presents to ED via EMS from nursing home for diaphoresis, altered mental status.  She was 'found like this' by nursing just prior to arrival to ED.  Patient has prior history of CVA, recovered.  Staff believed she may be having 'another stroke'."
	"1833657-1"	"1833657-1"	"FALL"	"10016173"	"65-79 years"	"65-79"	"4/27/21 visit to clinic: 74yr old female who has had off balance and leaning way to right and stumbling. This lasted short time.  By time sister got to view she was sitting in a chair. Some of these symptoms began 2 days before this visit and have been completely resolved since that time.   Patient has tried No medications.  7/9/21 clinic 75yr old female presents for referral to ortho for fracture of elbow and possible wrist.  Had fallen 6 days ago.  Was seen in ER and pout in posterior cast and told to see ortho when back here.  recommends for her to be seen by Specialist.  She may need a total elbow replacement.    9/12/21 ED Closed displaced fracture of medial epicondyle of right humerus, unspecified fracture morphology, initial encounter Acute  9/17/21 admit to nursing home H/O: CVA (cerebrovascular accident)   Dementia without behavioral disturbance, unspecified dementia type (HCC)   Cognitive safety issue     Plan: She will be admitted to nursing home on Tuesday, 9/21/2021.  We have asked her that the physical therapy would evaluate her for the best cane possible   10/29/21 Patient presents to ED via EMS from nursing home for diaphoresis, altered mental status.  She was 'found like this' by nursing just prior to arrival to ED.  Patient has prior history of CVA, recovered.  Staff believed she may be having 'another stroke'."
	"1833657-1"	"1833657-1"	"GAIT DISTURBANCE"	"10017577"	"65-79 years"	"65-79"	"4/27/21 visit to clinic: 74yr old female who has had off balance and leaning way to right and stumbling. This lasted short time.  By time sister got to view she was sitting in a chair. Some of these symptoms began 2 days before this visit and have been completely resolved since that time.   Patient has tried No medications.  7/9/21 clinic 75yr old female presents for referral to ortho for fracture of elbow and possible wrist.  Had fallen 6 days ago.  Was seen in ER and pout in posterior cast and told to see ortho when back here.  recommends for her to be seen by Specialist.  She may need a total elbow replacement.    9/12/21 ED Closed displaced fracture of medial epicondyle of right humerus, unspecified fracture morphology, initial encounter Acute  9/17/21 admit to nursing home H/O: CVA (cerebrovascular accident)   Dementia without behavioral disturbance, unspecified dementia type (HCC)   Cognitive safety issue     Plan: She will be admitted to nursing home on Tuesday, 9/21/2021.  We have asked her that the physical therapy would evaluate her for the best cane possible   10/29/21 Patient presents to ED via EMS from nursing home for diaphoresis, altered mental status.  She was 'found like this' by nursing just prior to arrival to ED.  Patient has prior history of CVA, recovered.  Staff believed she may be having 'another stroke'."
	"1833657-1"	"1833657-1"	"HUMERUS FRACTURE"	"10020462"	"65-79 years"	"65-79"	"4/27/21 visit to clinic: 74yr old female who has had off balance and leaning way to right and stumbling. This lasted short time.  By time sister got to view she was sitting in a chair. Some of these symptoms began 2 days before this visit and have been completely resolved since that time.   Patient has tried No medications.  7/9/21 clinic 75yr old female presents for referral to ortho for fracture of elbow and possible wrist.  Had fallen 6 days ago.  Was seen in ER and pout in posterior cast and told to see ortho when back here.  recommends for her to be seen by Specialist.  She may need a total elbow replacement.    9/12/21 ED Closed displaced fracture of medial epicondyle of right humerus, unspecified fracture morphology, initial encounter Acute  9/17/21 admit to nursing home H/O: CVA (cerebrovascular accident)   Dementia without behavioral disturbance, unspecified dementia type (HCC)   Cognitive safety issue     Plan: She will be admitted to nursing home on Tuesday, 9/21/2021.  We have asked her that the physical therapy would evaluate her for the best cane possible   10/29/21 Patient presents to ED via EMS from nursing home for diaphoresis, altered mental status.  She was 'found like this' by nursing just prior to arrival to ED.  Patient has prior history of CVA, recovered.  Staff believed she may be having 'another stroke'."
	"1833657-1"	"1833657-1"	"HYPERHIDROSIS"	"10020642"	"65-79 years"	"65-79"	"4/27/21 visit to clinic: 74yr old female who has had off balance and leaning way to right and stumbling. This lasted short time.  By time sister got to view she was sitting in a chair. Some of these symptoms began 2 days before this visit and have been completely resolved since that time.   Patient has tried No medications.  7/9/21 clinic 75yr old female presents for referral to ortho for fracture of elbow and possible wrist.  Had fallen 6 days ago.  Was seen in ER and pout in posterior cast and told to see ortho when back here.  recommends for her to be seen by Specialist.  She may need a total elbow replacement.    9/12/21 ED Closed displaced fracture of medial epicondyle of right humerus, unspecified fracture morphology, initial encounter Acute  9/17/21 admit to nursing home H/O: CVA (cerebrovascular accident)   Dementia without behavioral disturbance, unspecified dementia type (HCC)   Cognitive safety issue     Plan: She will be admitted to nursing home on Tuesday, 9/21/2021.  We have asked her that the physical therapy would evaluate her for the best cane possible   10/29/21 Patient presents to ED via EMS from nursing home for diaphoresis, altered mental status.  She was 'found like this' by nursing just prior to arrival to ED.  Patient has prior history of CVA, recovered.  Staff believed she may be having 'another stroke'."
	"1833657-1"	"1833657-1"	"MENTAL STATUS CHANGES"	"10048294"	"65-79 years"	"65-79"	"4/27/21 visit to clinic: 74yr old female who has had off balance and leaning way to right and stumbling. This lasted short time.  By time sister got to view she was sitting in a chair. Some of these symptoms began 2 days before this visit and have been completely resolved since that time.   Patient has tried No medications.  7/9/21 clinic 75yr old female presents for referral to ortho for fracture of elbow and possible wrist.  Had fallen 6 days ago.  Was seen in ER and pout in posterior cast and told to see ortho when back here.  recommends for her to be seen by Specialist.  She may need a total elbow replacement.    9/12/21 ED Closed displaced fracture of medial epicondyle of right humerus, unspecified fracture morphology, initial encounter Acute  9/17/21 admit to nursing home H/O: CVA (cerebrovascular accident)   Dementia without behavioral disturbance, unspecified dementia type (HCC)   Cognitive safety issue     Plan: She will be admitted to nursing home on Tuesday, 9/21/2021.  We have asked her that the physical therapy would evaluate her for the best cane possible   10/29/21 Patient presents to ED via EMS from nursing home for diaphoresis, altered mental status.  She was 'found like this' by nursing just prior to arrival to ED.  Patient has prior history of CVA, recovered.  Staff believed she may be having 'another stroke'."
	"1833657-1"	"1833657-1"	"UPPER LIMB FRACTURE"	"10061394"	"65-79 years"	"65-79"	"4/27/21 visit to clinic: 74yr old female who has had off balance and leaning way to right and stumbling. This lasted short time.  By time sister got to view she was sitting in a chair. Some of these symptoms began 2 days before this visit and have been completely resolved since that time.   Patient has tried No medications.  7/9/21 clinic 75yr old female presents for referral to ortho for fracture of elbow and possible wrist.  Had fallen 6 days ago.  Was seen in ER and pout in posterior cast and told to see ortho when back here.  recommends for her to be seen by Specialist.  She may need a total elbow replacement.    9/12/21 ED Closed displaced fracture of medial epicondyle of right humerus, unspecified fracture morphology, initial encounter Acute  9/17/21 admit to nursing home H/O: CVA (cerebrovascular accident)   Dementia without behavioral disturbance, unspecified dementia type (HCC)   Cognitive safety issue     Plan: She will be admitted to nursing home on Tuesday, 9/21/2021.  We have asked her that the physical therapy would evaluate her for the best cane possible   10/29/21 Patient presents to ED via EMS from nursing home for diaphoresis, altered mental status.  She was 'found like this' by nursing just prior to arrival to ED.  Patient has prior history of CVA, recovered.  Staff believed she may be having 'another stroke'."
	"1840693-1"	"1840693-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Case completed Covid vaccine series in March 2021, then was hospitalized for Covid, then died of Covid in September"
	"1840693-1"	"1840693-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Case completed Covid vaccine series in March 2021, then was hospitalized for Covid, then died of Covid in September"
	"1840693-1"	"1840693-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Case completed Covid vaccine series in March 2021, then was hospitalized for Covid, then died of Covid in September"
	"1840719-1"	"1840719-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Case completed covid vaccine series in APril 2021, then was hospitalized for COvid and subsequently died of Covid."
	"1840719-1"	"1840719-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Case completed covid vaccine series in APril 2021, then was hospitalized for COvid and subsequently died of Covid."
	"1840719-1"	"1840719-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Case completed covid vaccine series in APril 2021, then was hospitalized for COvid and subsequently died of Covid."
	"1842856-1"	"1842856-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away hours after receiving vaccination."
	"1846089-1"	"1846089-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"This case meets criteria for vaccine breakthrough review. Patient brought in unresponsive to ED, no known COVID SxS at the time."
	"1846689-1"	"1846689-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"65-79 years"	"65-79"	"/Patient presented to the emergency room on 10/23/2021 with cough and shortness of breath. He was found to be hypoxic and was admitted for further management. He was treated with remdesivir, dexamethasone, baricitinib, and supplemental oxygen. He condition worsened and he was transferred to the intensive care unit on 10/25/2021.  Patient was intubated on 10/29/2021. Patient's condition continued to worsen.  Patient had a pulselessness event on 11/5/2021 and code was called. Patient was unable to be resuscitated and he expired on 11/5/2021."
	"1846689-1"	"1846689-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"/Patient presented to the emergency room on 10/23/2021 with cough and shortness of breath. He was found to be hypoxic and was admitted for further management. He was treated with remdesivir, dexamethasone, baricitinib, and supplemental oxygen. He condition worsened and he was transferred to the intensive care unit on 10/25/2021.  Patient was intubated on 10/29/2021. Patient's condition continued to worsen.  Patient had a pulselessness event on 11/5/2021 and code was called. Patient was unable to be resuscitated and he expired on 11/5/2021."
	"1846689-1"	"1846689-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"/Patient presented to the emergency room on 10/23/2021 with cough and shortness of breath. He was found to be hypoxic and was admitted for further management. He was treated with remdesivir, dexamethasone, baricitinib, and supplemental oxygen. He condition worsened and he was transferred to the intensive care unit on 10/25/2021.  Patient was intubated on 10/29/2021. Patient's condition continued to worsen.  Patient had a pulselessness event on 11/5/2021 and code was called. Patient was unable to be resuscitated and he expired on 11/5/2021."
	"1846689-1"	"1846689-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"/Patient presented to the emergency room on 10/23/2021 with cough and shortness of breath. He was found to be hypoxic and was admitted for further management. He was treated with remdesivir, dexamethasone, baricitinib, and supplemental oxygen. He condition worsened and he was transferred to the intensive care unit on 10/25/2021.  Patient was intubated on 10/29/2021. Patient's condition continued to worsen.  Patient had a pulselessness event on 11/5/2021 and code was called. Patient was unable to be resuscitated and he expired on 11/5/2021."
	"1846689-1"	"1846689-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"/Patient presented to the emergency room on 10/23/2021 with cough and shortness of breath. He was found to be hypoxic and was admitted for further management. He was treated with remdesivir, dexamethasone, baricitinib, and supplemental oxygen. He condition worsened and he was transferred to the intensive care unit on 10/25/2021.  Patient was intubated on 10/29/2021. Patient's condition continued to worsen.  Patient had a pulselessness event on 11/5/2021 and code was called. Patient was unable to be resuscitated and he expired on 11/5/2021."
	"1846689-1"	"1846689-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"/Patient presented to the emergency room on 10/23/2021 with cough and shortness of breath. He was found to be hypoxic and was admitted for further management. He was treated with remdesivir, dexamethasone, baricitinib, and supplemental oxygen. He condition worsened and he was transferred to the intensive care unit on 10/25/2021.  Patient was intubated on 10/29/2021. Patient's condition continued to worsen.  Patient had a pulselessness event on 11/5/2021 and code was called. Patient was unable to be resuscitated and he expired on 11/5/2021."
	"1846689-1"	"1846689-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"/Patient presented to the emergency room on 10/23/2021 with cough and shortness of breath. He was found to be hypoxic and was admitted for further management. He was treated with remdesivir, dexamethasone, baricitinib, and supplemental oxygen. He condition worsened and he was transferred to the intensive care unit on 10/25/2021.  Patient was intubated on 10/29/2021. Patient's condition continued to worsen.  Patient had a pulselessness event on 11/5/2021 and code was called. Patient was unable to be resuscitated and he expired on 11/5/2021."
	"1846689-1"	"1846689-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"/Patient presented to the emergency room on 10/23/2021 with cough and shortness of breath. He was found to be hypoxic and was admitted for further management. He was treated with remdesivir, dexamethasone, baricitinib, and supplemental oxygen. He condition worsened and he was transferred to the intensive care unit on 10/25/2021.  Patient was intubated on 10/29/2021. Patient's condition continued to worsen.  Patient had a pulselessness event on 11/5/2021 and code was called. Patient was unable to be resuscitated and he expired on 11/5/2021."
	"1846689-1"	"1846689-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"/Patient presented to the emergency room on 10/23/2021 with cough and shortness of breath. He was found to be hypoxic and was admitted for further management. He was treated with remdesivir, dexamethasone, baricitinib, and supplemental oxygen. He condition worsened and he was transferred to the intensive care unit on 10/25/2021.  Patient was intubated on 10/29/2021. Patient's condition continued to worsen.  Patient had a pulselessness event on 11/5/2021 and code was called. Patient was unable to be resuscitated and he expired on 11/5/2021."
	"1846689-1"	"1846689-1"	"PULSE ABSENT"	"10037469"	"65-79 years"	"65-79"	"/Patient presented to the emergency room on 10/23/2021 with cough and shortness of breath. He was found to be hypoxic and was admitted for further management. He was treated with remdesivir, dexamethasone, baricitinib, and supplemental oxygen. He condition worsened and he was transferred to the intensive care unit on 10/25/2021.  Patient was intubated on 10/29/2021. Patient's condition continued to worsen.  Patient had a pulselessness event on 11/5/2021 and code was called. Patient was unable to be resuscitated and he expired on 11/5/2021."
	"1846689-1"	"1846689-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"/Patient presented to the emergency room on 10/23/2021 with cough and shortness of breath. He was found to be hypoxic and was admitted for further management. He was treated with remdesivir, dexamethasone, baricitinib, and supplemental oxygen. He condition worsened and he was transferred to the intensive care unit on 10/25/2021.  Patient was intubated on 10/29/2021. Patient's condition continued to worsen.  Patient had a pulselessness event on 11/5/2021 and code was called. Patient was unable to be resuscitated and he expired on 11/5/2021."
	"1846878-1"	"1846878-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient expired 11/4/2021."
	"1849492-1"	"1849492-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"CEREBROVASCULAR ACCIDENT"	"10008190"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"COMPUTERISED TOMOGRAM ABNORMAL"	"10010235"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"DYSGRAPHIA"	"10058319"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"DYSSTASIA"	"10050256"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"ELECTROCARDIOGRAM NORMAL"	"10014373"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"GAIT DISTURBANCE"	"10017577"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"HEMIPARESIS"	"10019465"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"INSOMNIA"	"10022437"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"LABORATORY TEST"	"10059938"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES"	"10079487"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"MOBILITY DECREASED"	"10048334"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"NERVOUS SYSTEM DISORDER"	"10029202"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"PERIPHERAL SWELLING"	"10048959"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"PNEUMONIA"	"10035664"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"PULMONARY THROMBOSIS"	"10037437"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"SPEECH DISORDER"	"10041466"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1849492-1"	"1849492-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"Within 12 hours, could not sleep, had body aches, and loss of strength.  Could not stand up from a seated position by herself.  Condition continued to worsen.  Saw personal physician on Feb. 26 and at that point was very weak and fatigued from continued inability to sleep.  Was taken to the ER on March 2 and admitted into the hospital.  At that point she could not communicate / talk, she could not sign her name, and could barely walk with a great deal of help.  EKG was normal.  Found signs of a mild stroke on the left side of her brain and had neurological issues on the left side of her body to the point that she could not use her left arm or leg.  Had swelling in her legs that would not dissipate.  Was released from the hospital on March 28 and transferred to a rehab facility with continued plans of strengthening and return to home.  She still could not stand or walk on her own and barely with two people helping her at maximum assistance.  On April 2, she was transferred from the rehab facility to the ER by ambulance due to worsening condition and not responsive but heart was fine.  Was transferred back to the rehab facility that night after being treated.  On April 6 was transferred to Hospital due to her condition worsening again.  Found a large blood clot in her right lung.  At this point she could no longer move herself due to weakness and continued neurological issues of her left side.  Heart continued to be strong.  She passed away on April 16, 2021.  Cause of death is unknown."
	"1850452-1"	"1850452-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Dose 1 2/8/2021 Lot # EN5318 Pfizer.  Pt died in the hospital"
	"1854556-1"	"1854556-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"vaccine Dose 1  given 3/30/2021 Moderna Lot # 020B21A Pt died in the ER following a motor vehicle accident"
	"1854556-1"	"1854556-1"	"ROAD TRAFFIC ACCIDENT"	"10039203"	"65-79 years"	"65-79"	"vaccine Dose 1  given 3/30/2021 Moderna Lot # 020B21A Pt died in the ER following a motor vehicle accident"
	"1854576-1"	"1854576-1"	"CARDIAC FAILURE"	"10007554"	"65-79 years"	"65-79"	"Vaccine dose 1 given 2/2/2021, Lot # N/A Moderna  Patient died of Covid 19, heart failure on 11/8/2021"
	"1854576-1"	"1854576-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Vaccine dose 1 given 2/2/2021, Lot # N/A Moderna  Patient died of Covid 19, heart failure on 11/8/2021"
	"1854576-1"	"1854576-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Vaccine dose 1 given 2/2/2021, Lot # N/A Moderna  Patient died of Covid 19, heart failure on 11/8/2021"
	"1854606-1"	"1854606-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"loss of appetite, nausea, diarrhea, within 1st day.  passed out on day 6 - cardio Dr said was an effect of low insulin levels. By day 9 she was having difficulty breathing.  Was admitted to hospital that day for oxygen.  5 days after entering hospital was placed on ventilator.  Died 14 days later."
	"1854606-1"	"1854606-1"	"DECREASED APPETITE"	"10061428"	"65-79 years"	"65-79"	"loss of appetite, nausea, diarrhea, within 1st day.  passed out on day 6 - cardio Dr said was an effect of low insulin levels. By day 9 she was having difficulty breathing.  Was admitted to hospital that day for oxygen.  5 days after entering hospital was placed on ventilator.  Died 14 days later."
	"1854606-1"	"1854606-1"	"DIARRHOEA"	"10012735"	"65-79 years"	"65-79"	"loss of appetite, nausea, diarrhea, within 1st day.  passed out on day 6 - cardio Dr said was an effect of low insulin levels. By day 9 she was having difficulty breathing.  Was admitted to hospital that day for oxygen.  5 days after entering hospital was placed on ventilator.  Died 14 days later."
	"1854606-1"	"1854606-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"loss of appetite, nausea, diarrhea, within 1st day.  passed out on day 6 - cardio Dr said was an effect of low insulin levels. By day 9 she was having difficulty breathing.  Was admitted to hospital that day for oxygen.  5 days after entering hospital was placed on ventilator.  Died 14 days later."
	"1854606-1"	"1854606-1"	"LOSS OF CONSCIOUSNESS"	"10024855"	"65-79 years"	"65-79"	"loss of appetite, nausea, diarrhea, within 1st day.  passed out on day 6 - cardio Dr said was an effect of low insulin levels. By day 9 she was having difficulty breathing.  Was admitted to hospital that day for oxygen.  5 days after entering hospital was placed on ventilator.  Died 14 days later."
	"1854606-1"	"1854606-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"loss of appetite, nausea, diarrhea, within 1st day.  passed out on day 6 - cardio Dr said was an effect of low insulin levels. By day 9 she was having difficulty breathing.  Was admitted to hospital that day for oxygen.  5 days after entering hospital was placed on ventilator.  Died 14 days later."
	"1854606-1"	"1854606-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"loss of appetite, nausea, diarrhea, within 1st day.  passed out on day 6 - cardio Dr said was an effect of low insulin levels. By day 9 she was having difficulty breathing.  Was admitted to hospital that day for oxygen.  5 days after entering hospital was placed on ventilator.  Died 14 days later."
	"1854606-1"	"1854606-1"	"TYPE 1 DIABETES MELLITUS"	"10067584"	"65-79 years"	"65-79"	"loss of appetite, nausea, diarrhea, within 1st day.  passed out on day 6 - cardio Dr said was an effect of low insulin levels. By day 9 she was having difficulty breathing.  Was admitted to hospital that day for oxygen.  5 days after entering hospital was placed on ventilator.  Died 14 days later."
	"1854818-1"	"1854818-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Death"
	"1854818-1"	"1854818-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death"
	"1854818-1"	"1854818-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Death"
	"1854838-1"	"1854838-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death"
	"1857856-1"	"1857856-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"SOB, CYANOTIC,"
	"1857856-1"	"1857856-1"	"CYANOSIS"	"10011703"	"65-79 years"	"65-79"	"SOB, CYANOTIC,"
	"1857856-1"	"1857856-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"SOB, CYANOTIC,"
	"1857856-1"	"1857856-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"SOB, CYANOTIC,"
	"1861132-1"	"1861132-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/21/2021 with mild confusion, weakness and fatigue. he also had a cough and increased shortness of breath. He was found to be COVID-19 positive and admitted for further management. Patient's condition did not improve and was transferred to the intensive care unit on 10/4/2021 and intubated on 10/4/2021. Patient was placed comfort measure due to worsening of condition on ***. Patient expired on 10/6/2021 from multi-system organ failure."
	"1861132-1"	"1861132-1"	"CONFUSIONAL STATE"	"10010305"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/21/2021 with mild confusion, weakness and fatigue. he also had a cough and increased shortness of breath. He was found to be COVID-19 positive and admitted for further management. Patient's condition did not improve and was transferred to the intensive care unit on 10/4/2021 and intubated on 10/4/2021. Patient was placed comfort measure due to worsening of condition on ***. Patient expired on 10/6/2021 from multi-system organ failure."
	"1861132-1"	"1861132-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/21/2021 with mild confusion, weakness and fatigue. he also had a cough and increased shortness of breath. He was found to be COVID-19 positive and admitted for further management. Patient's condition did not improve and was transferred to the intensive care unit on 10/4/2021 and intubated on 10/4/2021. Patient was placed comfort measure due to worsening of condition on ***. Patient expired on 10/6/2021 from multi-system organ failure."
	"1861132-1"	"1861132-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/21/2021 with mild confusion, weakness and fatigue. he also had a cough and increased shortness of breath. He was found to be COVID-19 positive and admitted for further management. Patient's condition did not improve and was transferred to the intensive care unit on 10/4/2021 and intubated on 10/4/2021. Patient was placed comfort measure due to worsening of condition on ***. Patient expired on 10/6/2021 from multi-system organ failure."
	"1861132-1"	"1861132-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/21/2021 with mild confusion, weakness and fatigue. he also had a cough and increased shortness of breath. He was found to be COVID-19 positive and admitted for further management. Patient's condition did not improve and was transferred to the intensive care unit on 10/4/2021 and intubated on 10/4/2021. Patient was placed comfort measure due to worsening of condition on ***. Patient expired on 10/6/2021 from multi-system organ failure."
	"1861132-1"	"1861132-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/21/2021 with mild confusion, weakness and fatigue. he also had a cough and increased shortness of breath. He was found to be COVID-19 positive and admitted for further management. Patient's condition did not improve and was transferred to the intensive care unit on 10/4/2021 and intubated on 10/4/2021. Patient was placed comfort measure due to worsening of condition on ***. Patient expired on 10/6/2021 from multi-system organ failure."
	"1861132-1"	"1861132-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/21/2021 with mild confusion, weakness and fatigue. he also had a cough and increased shortness of breath. He was found to be COVID-19 positive and admitted for further management. Patient's condition did not improve and was transferred to the intensive care unit on 10/4/2021 and intubated on 10/4/2021. Patient was placed comfort measure due to worsening of condition on ***. Patient expired on 10/6/2021 from multi-system organ failure."
	"1861132-1"	"1861132-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/21/2021 with mild confusion, weakness and fatigue. he also had a cough and increased shortness of breath. He was found to be COVID-19 positive and admitted for further management. Patient's condition did not improve and was transferred to the intensive care unit on 10/4/2021 and intubated on 10/4/2021. Patient was placed comfort measure due to worsening of condition on ***. Patient expired on 10/6/2021 from multi-system organ failure."
	"1861132-1"	"1861132-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/21/2021 with mild confusion, weakness and fatigue. he also had a cough and increased shortness of breath. He was found to be COVID-19 positive and admitted for further management. Patient's condition did not improve and was transferred to the intensive care unit on 10/4/2021 and intubated on 10/4/2021. Patient was placed comfort measure due to worsening of condition on ***. Patient expired on 10/6/2021 from multi-system organ failure."
	"1861132-1"	"1861132-1"	"MULTIPLE ORGAN DYSFUNCTION SYNDROME"	"10077361"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/21/2021 with mild confusion, weakness and fatigue. he also had a cough and increased shortness of breath. He was found to be COVID-19 positive and admitted for further management. Patient's condition did not improve and was transferred to the intensive care unit on 10/4/2021 and intubated on 10/4/2021. Patient was placed comfort measure due to worsening of condition on ***. Patient expired on 10/6/2021 from multi-system organ failure."
	"1861132-1"	"1861132-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient presented to emergency room on 9/21/2021 with mild confusion, weakness and fatigue. he also had a cough and increased shortness of breath. He was found to be COVID-19 positive and admitted for further management. Patient's condition did not improve and was transferred to the intensive care unit on 10/4/2021 and intubated on 10/4/2021. Patient was placed comfort measure due to worsening of condition on ***. Patient expired on 10/6/2021 from multi-system organ failure."
	"1864913-1"	"1864913-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"ANAEMIA MACROCYTIC"	"10002064"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"ATRIAL FIBRILLATION"	"10003658"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"ATRIOVENTRICULAR BLOCK COMPLETE"	"10003673"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"AZOTAEMIA"	"10003885"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"BACTERAEMIA"	"10003997"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"BLOOD CREATININE INCREASED"	"10005483"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"BLOOD CULTURE POSITIVE"	"10005488"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"BLOOD LACTATE DEHYDROGENASE"	"10005626"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"BLOOD LACTIC ACID"	"10005632"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"C-REACTIVE PROTEIN INCREASED"	"10006825"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"CARDIAC PACEMAKER INSERTION"	"10007598"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"CARDIAC VALVE VEGETATION"	"10057651"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"CHRONIC KIDNEY DISEASE"	"10064848"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"COMPUTERISED TOMOGRAM HEAD NORMAL"	"10072167"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"CONFUSIONAL STATE"	"10010305"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"CREATININE URINE"	"10049696"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"DELIRIUM"	"10012218"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"DYSARTHRIA"	"10013887"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"ECHOCARDIOGRAM"	"10014113"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"ELECTROCARDIOGRAM ABNORMAL"	"10014363"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"ENCEPHALOPATHY"	"10014625"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"ENDOCARDITIS"	"10014665"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"ESCHERICHIA INFECTION"	"10061126"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"FIBRIN D DIMER"	"10016577"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"GLOMERULAR FILTRATION RATE NORMAL"	"10018361"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"HAEMOGLOBIN DECREASED"	"10018884"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"HEART RATE IRREGULAR"	"10019304"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"HYPERKALAEMIA"	"10020646"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"HYPORESPONSIVE TO STIMULI"	"10071552"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"ILLNESS"	"10080284"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"INFECTION"	"10021789"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"INTERNATIONAL NORMALISED RATIO INCREASED"	"10022595"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"LABORATORY TEST"	"10059938"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"LEGIONELLA TEST"	"10070410"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"LUNG OPACITY"	"10081792"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"MENTAL STATUS CHANGES"	"10048294"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"MOBILITY DECREASED"	"10048334"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"NOTHING BY MOUTH ORDER"	"10080668"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"PERIPHERAL COLDNESS"	"10034568"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"PLATELET COUNT DECREASED"	"10035528"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"PROCALCITONIN INCREASED"	"10067081"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"PUPIL FIXED"	"10037515"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"RENAL ATROPHY"	"10038381"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"RESPIRATORY VIRAL PANEL"	"10075165"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"SEPSIS"	"10040047"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"SERUM FERRITIN"	"10040246"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"SOMNOLENCE"	"10041349"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"STREPTOCOCCUS TEST"	"10070414"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"THROMBOCYTOPENIA"	"10043554"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"TROPONIN INCREASED"	"10058267"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"ULTRASOUND KIDNEY ABNORMAL"	"10045422"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"UREA URINE"	"10050710"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"URINARY TRACT INFECTION"	"10046571"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"URINE ANALYSIS"	"10046614"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1864913-1"	"1864913-1"	"URINE SODIUM"	"10049510"	"65-79 years"	"65-79"	"Chief Complaint   altered mental status  History of Present Illness     Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from  Hospital for altered mentation. Patient is confused on exam and somnolent thus most of history is per outside record. He came to the facility from another location due to having fever, slurred speech, change in mentation. Nursing home reported that patient was well 2 days ago, answering questions appropriately, participating in therapy, and following instruction until the acute change. At the facility, patient had CT head which was negative for acute intracranial bleed. EKG showed afib with paced ventricular complexes. He was found to be Covid positive and had soft blood pressure 93/48. He was given 1L IVF and was started on dexamethasone and azithromycin. He was then transferred to ICU for concern of sepsis. Of note, facility record mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics.   Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Nurse after speaking to family stated that his mental status had been like this for the past 6 months. Attempted to reach family by phone but was unsucessful.  Of note, he was seen at hospital (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to SNF on ertapenem to be continued until 11/5/21.  Review of Systems     Unable to be performed due to patient's altered mentation   Physical Exam  Vitals & Measurements  T: 36.3 ¦C  TMIN: 36.3 ¦C  TMAX: 36.8 ¦C  HR: 87  RR: 22  BP: 95/64  SpO2: 92%  WT: 187.4 kg (Dosing)  BMI: 57.8      General:  Alert Eye:  Extraocular movements are intact, conjunctiva pale HENMT:  Normocephalic, Normal hearing, Oral mucosa moist. Respiratory:  Lungs are clear to auscultation, Respirations are non-labored. On 2L NC Cardiovascular:  irregular rate, Normal rhythm, No murmur appreciated. Gastrointestinal:  Soft, no tenderness to palpation throughout,  BS active Musculoskeletal: No peripheral edema. Integumentary:  Skin is warm, dry Neurologic:  A&Ox0, following some commands. Somnolent Psychiatric: Somnolent, unable to further assess  Assessment/Plan      Patient is a 78 years old male with hx of flaccid hemiplegia of R + L side, dysphagia, CAD (s/p CABGx3 in 2018), ESBL infectious endocarditis, OSA, HLD, pAF on Eliquis, hx of hear block s/p pacemaker who is a transfer from Hospital for altered mentation. CT head was negative for acute intracranial bleed. Patient was found to be Covid positive and hypotensive thus was transferred to ICU for further management. Initial vitals at facility were notable for blood pressure 95/64 and sat >92% on 2L. Patient was only oriented to self and intermittently followed command but otherwise remained confuse and somnolent. EKG showed afib with ventricular paced rhythm. Labs were notable for Hgb 7.2, plt 66, Cr 3.05, trop 306 (delta trop negative), procalc 21.4, CRP 22.47, and non-elevated lactic acid 1.6. Encephalopathy is questionable given report from family that patient has been having cognitive impairment/delirium since last admission below. Additionally, ED mentioned that patient was supposed to be on 6 weeks IV antibiotics for infective endocarditis, but somehow was only on 5 days of PO antibiotics. Plan to treat patient empiri   Of note, he was seen at hospitalr (admitted 9/22/21-10/21/21) and diagnosed with severe sepsis secondary to endocarditis from ESBL E. Coli (E. Coli sensitive to zosyn) and was treated with ertapenem. He also had UTI with ESBL E. Coli at that time. Document reported persistent delirium secondary to severe illness. Hospital course was complicated by complete heart block suspect from endocarditis with RV PPM placed 9/29/21. He was discharged to facility on ertapenem to be continued until 11/5/21.   Neuro:  Encephalopathy suspects infectious  Hx of persistent delirium  - CT Head at facility negative for acute intracranial abnormality  - request overread CT head  - continue antibiotics  - consider MRI head to further evaluate stroke  - consider EEG if encephalopathy not improved on antibiotics   Cardiovascular:  ESBL E. Coli Endocarditis on Imipenem at facility  paroxysmal Afib (CHA2DS2-VASC 4) on apixaban  Heart block s/p RV Pacemaker (9/29/21)  HTN  - EKG: afib with ventricular paced rhythm  - Troponin elevated but likely chronic (delta troponin 0)  - reported only on 5 days of PO abx instead of 6 weeks IV abx  - request records from hospital  - obtain TEE to assess for vegetation  - cont vanc and zosyn  - follow blood culture  - hold home apixaban in case of procedure  - hold home lisinopril and amlodipine due to c/f hypotension   Pulm:  Hypoxia suspects secondary to Covid pneumonia   - CXR: bilateral airspace opacities R>L  - cont dexamethasone  - hold remdesivir due to impaired renal clearance eGFR < 30  - urine strep, urine legionella  - RPP, pneumonia panel  - procalcitonin, CRP, ferritin, D-dimer, LDH   GI:  - NPO for now  - bowel regiment   Renal:  AKI on CKD  - UA  - urine na, urine urea, urine creatinine  - renal ultrasound   ID:   Covid Pneumonia  ESBL E Coli Endocarditis  - obtain urine culture  - obtain blood culture  - obtain sputum culture  - urine strep, urine legionella  - RPP, pneumonia panel   - cont dexamethasone for Covid (11/6-p)   Abx:  - vancomycin (11/6-p)  - zosyn (11/6-p)   Endo:  - no acute concern   Heme-Onc:  Thrombocytopenia suspects secondary to infection  Macrocytic Anemia  - obtain iron panel  - obtain B12, folate level   Code: Full  Dispo: ICU  DVT ppx: hold due to elevated INR  Diet: NPO   Patient staffed with attending Addendum by MD, on November 08, 2021 10:22:55 (Verified)    Pt. seen/examined by me 11-6-21, labs/findings reviewed/confirmed by me, images viewed/interpreted by me, and agree with this note by Dr.  Patient, although COVID positive, is remarkably ill from gram negative endocarditis, with recurrence of bacteremia now following completion of primary course, which was complicated by heart conduction issues for which a pacer was placed, now possibly also source of infection.  He is hypoxemic, potentially due to concurrent COVID for which therapy is underway, and although he is alert and awake is almost completely unresponsive, remarkably confused.  Blood cultures are already positive this am, revealing heavy bacteremia almost certainly  from endocarditis.  Prognosis is very poor without removal of pacer and likely valve replacement, however details of his endocarditis are not yet complete, records from facility have been requested and pt is currently too ill to undergo any surgical management.  Have switched zosyn to ertapenem as risk that E. coli is resistant, and have d/c vancomycin.  Total time >31mins cc by me. Date of Admission  11/05/2021   Date of Discharge  11/10/2021   Reason for Hospitalization   Infective endocarditis  Hospital Course       78 y/o male with paroxysmal atrial fibrillation on Eliquis, CAD s/p CABG, ESBL E. coli endocarditis induced heart block s/p R heart pacemaker placement 9/29 (Boston scientific), incomplete treatment duration of endocarditis (~4 weeks out of 6), who was readmitted for septic encephalopathy in setting of ESBL bacteremia. Blood cultures positive for E. coli treated with Ertapenem. Oliguric renal failure appears to chronic given renal US on 11/6 which showed atrophy without obstruction. TEE showed mitral valve vegetation. Patient is not a candidate for definitive surgical management per CT surgery. Son would like DNAR, comfort care. Started treatment for hyperkalemia prior to goals of care discussion. Stopping antibiotics. Family en route.  Discharge Diagnoses      COVID-19   Vaccinated. Treated, on room air.   Infective endocarditis   Treat with IV abx, not open heart surgical candidate given comorbidities. Decision was made to pursue comfort care.   Encephalopathy      1 month prior to admission, concern for septic emboli or anoxic brain injury prior to arrival. Developed Uremia as well  Acute renal failure      Declined dialysis as family decided to pursue comfort care.  Other Diagnoses   Ongoing  No qualifying data  Historical  No qualifying data    Consultants  Medicine Cardiology    Medicine Infectious Disease    Supportive/Palliative Care   Pending Labs  Blood Culture (Preliminary, InProcess, ordered 11/08/2021, 13:10)   Discharge Disposition  Skilled Nursing Facility    Medications  New, Changed, or Refilled Medications  None    Medications to be Continued  acetaminophen (acetaminophen 650 mg, 2 Tablet(s), Oral, q4h, PRN: pain/fever    albuterol (albuterol  HFA 90 2 Puff, Inhalation, q6h, for 30 day(s), PRN: Wheezing, 0 Refill(s)    apixaban (apixaban 5 mg) 5 mg, Oral, bid, 0 Refill(s)    atorvastatin (atorvastatin 2 20 mg, 1 Tablet(s), Oral, At Bedtime, 0 Refill(s)    lisinopril (lisinopril 20 mg 20 mg, 1 Tablet(s), Oral, Daily, 0 Refill(s)    modafinil (modafinil 200 mg) 200 mg, 1 Tablet(s), Oral, qAM, 0 Refill(s)      Discontinued Medications  None  Physical Exam at Discharge  Vitals & Measurements  T: 36.7 ¦C  TMIN: 36.7 ¦C  TMAX: 36.8 ¦C  HR: 83  RR: 36  BP: 138/71  SpO2: 94%      General:  Resting, non responsive HENMT:  Fixed pupils Respiratory:  No chest rise Cardiovascular:  No peripheral edema. Gastrointestinal:  Non-distended Musculoskeletal: Absence of movement Integumentary:  Skin is cold Neurologic:  Fixed pupils, no response to verbal, tactile stimulation Psychiatric: Unable to assess  Time Spent  >30 minutes       Nursing/Other Orders   Regular Diet. Ordered on 11/10/21 12:45:00 Meal Start Time Breakfast 0700 to 0900   Sofcare Static Air Seat Cushion. 11/08/21 10:31:00, when out of bed to chair   Fall Precautions. 11/05/21 20:08:27. Order comment: order placed from nursing documentation CLIN_FALL_RISK   Code Status. Code Status Description: DNAR (Do Not Attempt Resuscitation)   Oxygen Instructions. 11/10/21 12:45:00, Routine, Instructions Titrate to comfort. No O2 Saturation Monitoring. Order comment:"
	"1865574-1"	"1865574-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 10/16/2021"
	"1865583-1"	"1865583-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 10/19/2021"
	"1869204-1"	"1869204-1"	"CHEST X-RAY"	"10008498"	"65-79 years"	"65-79"	"Patient was diagnosed with COVID on October 13. came to the ER with respiratory distress from nursing home on November 4th.  Signs and symptoms:  shortness of breath Pulse ox on the scene was 70% on oxygen.  Treatment: 100% oxygen.(intubation)"
	"1869204-1"	"1869204-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient was diagnosed with COVID on October 13. came to the ER with respiratory distress from nursing home on November 4th.  Signs and symptoms:  shortness of breath Pulse ox on the scene was 70% on oxygen.  Treatment: 100% oxygen.(intubation)"
	"1869204-1"	"1869204-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient was diagnosed with COVID on October 13. came to the ER with respiratory distress from nursing home on November 4th.  Signs and symptoms:  shortness of breath Pulse ox on the scene was 70% on oxygen.  Treatment: 100% oxygen.(intubation)"
	"1869204-1"	"1869204-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Patient was diagnosed with COVID on October 13. came to the ER with respiratory distress from nursing home on November 4th.  Signs and symptoms:  shortness of breath Pulse ox on the scene was 70% on oxygen.  Treatment: 100% oxygen.(intubation)"
	"1869204-1"	"1869204-1"	"RESPIRATORY DISTRESS"	"10038687"	"65-79 years"	"65-79"	"Patient was diagnosed with COVID on October 13. came to the ER with respiratory distress from nursing home on November 4th.  Signs and symptoms:  shortness of breath Pulse ox on the scene was 70% on oxygen.  Treatment: 100% oxygen.(intubation)"
	"1869204-1"	"1869204-1"	"SARS-COV-2 TEST"	"10084354"	"65-79 years"	"65-79"	"Patient was diagnosed with COVID on October 13. came to the ER with respiratory distress from nursing home on November 4th.  Signs and symptoms:  shortness of breath Pulse ox on the scene was 70% on oxygen.  Treatment: 100% oxygen.(intubation)"
	"1869473-1"	"1869473-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Unknown at time of vaccination"
	"1872954-1"	"1872954-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient vaccinated against and then tested positive for COVID-19"
	"1872954-1"	"1872954-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient vaccinated against and then tested positive for COVID-19"
	"1876697-1"	"1876697-1"	"CHRONIC OBSTRUCTIVE PULMONARY DISEASE"	"10009033"	"65-79 years"	"65-79"	"Covid vaccine #1 given 2/9/2021 Moderna, lot # n/a patient died in the hospital from COPD, failure to thrive, not a covid infection"
	"1876697-1"	"1876697-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Covid vaccine #1 given 2/9/2021 Moderna, lot # n/a patient died in the hospital from COPD, failure to thrive, not a covid infection"
	"1876697-1"	"1876697-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Covid vaccine #1 given 2/9/2021 Moderna, lot # n/a patient died in the hospital from COPD, failure to thrive, not a covid infection"
	"1876697-1"	"1876697-1"	"FAILURE TO THRIVE"	"10016165"	"65-79 years"	"65-79"	"Covid vaccine #1 given 2/9/2021 Moderna, lot # n/a patient died in the hospital from COPD, failure to thrive, not a covid infection"
	"1880071-1"	"1880071-1"	"ACUTE LEFT VENTRICULAR FAILURE"	"10063081"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"ACUTE RESPIRATORY DISTRESS SYNDROME"	"10001052"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"ANTICOAGULANT THERAPY"	"10053468"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"ASPERGILLUS TEST"	"10070450"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"BLOOD BETA-D-GLUCAN"	"10068725"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"CARDIAC FAILURE CONGESTIVE"	"10007559"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"CHRONIC LEFT VENTRICULAR FAILURE"	"10063083"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"ECHOCARDIOGRAM NORMAL"	"10014115"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"EJECTION FRACTION"	"10050527"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"FIBRIN D DIMER INCREASED"	"10016581"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"POLYURIA"	"10036142"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"SPUTUM CULTURE POSITIVE"	"10051612"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880071-1"	"1880071-1"	"ULTRASOUND DOPPLER NORMAL"	"10045414"	"65-79 years"	"65-79"	"Patient is Deceased.  Date of Death: 11/15/21 Time of Death:  7:40 PM Preliminary Cause of Death: COVID-19   See VAERS #706111 for initial hospitalization reporting.   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions.  Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however.  Patient's condition declined.  Wife wished to proceed with comfprt care measures on 11/15/2021.  Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside."
	"1880333-1"	"1880333-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"patient now deceased.  Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization  DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia.  Resolved. 9. Hypocalcemia.  Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath.  She tested positive for COVID.  She was treated with Decadron, then Solu-Medrol, and remdesivir.  Unfortunately, the patient's clinical course deteriorated and she required intubation on 10/30.  Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate.  After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days.  It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy.  Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state.  They agreed that care was futile.  They agreed to remove life support on 11/12 and the patient succumbed to her disease process.  She passed and was pronounced at 5:46 p.m. on 11/12/2021."
	"1880333-1"	"1880333-1"	"ATRIAL FIBRILLATION"	"10003658"	"65-79 years"	"65-79"	"patient now deceased.  Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization  DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia.  Resolved. 9. Hypocalcemia.  Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath.  She tested positive for COVID.  She was treated with Decadron, then Solu-Medrol, and remdesivir.  Unfortunately, the patient's clinical course deteriorated and she required intubation on 10/30.  Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate.  After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days.  It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy.  Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state.  They agreed that care was futile.  They agreed to remove life support on 11/12 and the patient succumbed to her disease process.  She passed and was pronounced at 5:46 p.m. on 11/12/2021."
	"1880333-1"	"1880333-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"patient now deceased.  Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization  DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia.  Resolved. 9. Hypocalcemia.  Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath.  She tested positive for COVID.  She was treated with Decadron, then Solu-Medrol, and remdesivir.  Unfortunately, the patient's clinical course deteriorated and she required intubation on 10/30.  Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate.  After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days.  It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy.  Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state.  They agreed that care was futile.  They agreed to remove life support on 11/12 and the patient succumbed to her disease process.  She passed and was pronounced at 5:46 p.m. on 11/12/2021."
	"1880333-1"	"1880333-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"patient now deceased.  Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization  DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia.  Resolved. 9. Hypocalcemia.  Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath.  She tested positive for COVID.  She was treated with Decadron, then Solu-Medrol, and remdesivir.  Unfortunately, the patient's clinical course deteriorated and she required intubation on 10/30.  Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate.  After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days.  It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy.  Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state.  They agreed that care was futile.  They agreed to remove life support on 11/12 and the patient succumbed to her disease process.  She passed and was pronounced at 5:46 p.m. on 11/12/2021."
	"1880333-1"	"1880333-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"patient now deceased.  Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization  DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia.  Resolved. 9. Hypocalcemia.  Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath.  She tested positive for COVID.  She was treated with Decadron, then Solu-Medrol, and remdesivir.  Unfortunately, the patient's clinical course deteriorated and she required intubation on 10/30.  Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate.  After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days.  It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy.  Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state.  They agreed that care was futile.  They agreed to remove life support on 11/12 and the patient succumbed to her disease process.  She passed and was pronounced at 5:46 p.m. on 11/12/2021."
	"1880333-1"	"1880333-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"patient now deceased.  Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization  DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia.  Resolved. 9. Hypocalcemia.  Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath.  She tested positive for COVID.  She was treated with Decadron, then Solu-Medrol, and remdesivir.  Unfortunately, the patient's clinical course deteriorated and she required intubation on 10/30.  Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate.  After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days.  It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy.  Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state.  They agreed that care was futile.  They agreed to remove life support on 11/12 and the patient succumbed to her disease process.  She passed and was pronounced at 5:46 p.m. on 11/12/2021."
	"1880333-1"	"1880333-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"patient now deceased.  Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization  DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia.  Resolved. 9. Hypocalcemia.  Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath.  She tested positive for COVID.  She was treated with Decadron, then Solu-Medrol, and remdesivir.  Unfortunately, the patient's clinical course deteriorated and she required intubation on 10/30.  Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate.  After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days.  It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy.  Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state.  They agreed that care was futile.  They agreed to remove life support on 11/12 and the patient succumbed to her disease process.  She passed and was pronounced at 5:46 p.m. on 11/12/2021."
	"1880333-1"	"1880333-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"patient now deceased.  Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization  DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia.  Resolved. 9. Hypocalcemia.  Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath.  She tested positive for COVID.  She was treated with Decadron, then Solu-Medrol, and remdesivir.  Unfortunately, the patient's clinical course deteriorated and she required intubation on 10/30.  Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate.  After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days.  It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy.  Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state.  They agreed that care was futile.  They agreed to remove life support on 11/12 and the patient succumbed to her disease process.  She passed and was pronounced at 5:46 p.m. on 11/12/2021."
	"1880333-1"	"1880333-1"	"HYPERKALAEMIA"	"10020646"	"65-79 years"	"65-79"	"patient now deceased.  Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization  DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia.  Resolved. 9. Hypocalcemia.  Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath.  She tested positive for COVID.  She was treated with Decadron, then Solu-Medrol, and remdesivir.  Unfortunately, the patient's clinical course deteriorated and she required intubation on 10/30.  Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate.  After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days.  It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy.  Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state.  They agreed that care was futile.  They agreed to remove life support on 11/12 and the patient succumbed to her disease process.  She passed and was pronounced at 5:46 p.m. on 11/12/2021."
	"1880333-1"	"1880333-1"	"HYPOCALCAEMIA"	"10020947"	"65-79 years"	"65-79"	"patient now deceased.  Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization  DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia.  Resolved. 9. Hypocalcemia.  Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath.  She tested positive for COVID.  She was treated with Decadron, then Solu-Medrol, and remdesivir.  Unfortunately, the patient's clinical course deteriorated and she required intubation on 10/30.  Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate.  After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days.  It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy.  Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state.  They agreed that care was futile.  They agreed to remove life support on 11/12 and the patient succumbed to her disease process.  She passed and was pronounced at 5:46 p.m. on 11/12/2021."
	"1880333-1"	"1880333-1"	"LOW LUNG COMPLIANCE"	"10086117"	"65-79 years"	"65-79"	"patient now deceased.  Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization  DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia.  Resolved. 9. Hypocalcemia.  Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath.  She tested positive for COVID.  She was treated with Decadron, then Solu-Medrol, and remdesivir.  Unfortunately, the patient's clinical course deteriorated and she required intubation on 10/30.  Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate.  After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days.  It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy.  Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state.  They agreed that care was futile.  They agreed to remove life support on 11/12 and the patient succumbed to her disease process.  She passed and was pronounced at 5:46 p.m. on 11/12/2021."
	"1880333-1"	"1880333-1"	"PNEUMOMEDIASTINUM"	"10050184"	"65-79 years"	"65-79"	"patient now deceased.  Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization  DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia.  Resolved. 9. Hypocalcemia.  Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath.  She tested positive for COVID.  She was treated with Decadron, then Solu-Medrol, and remdesivir.  Unfortunately, the patient's clinical course deteriorated and she required intubation on 10/30.  Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate.  After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days.  It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy.  Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state.  They agreed that care was futile.  They agreed to remove life support on 11/12 and the patient succumbed to her disease process.  She passed and was pronounced at 5:46 p.m. on 11/12/2021."
	"1880333-1"	"1880333-1"	"PNEUMONIA"	"10035664"	"65-79 years"	"65-79"	"patient now deceased.  Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization  DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia.  Resolved. 9. Hypocalcemia.  Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath.  She tested positive for COVID.  She was treated with Decadron, then Solu-Medrol, and remdesivir.  Unfortunately, the patient's clinical course deteriorated and she required intubation on 10/30.  Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate.  After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days.  It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy.  Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state.  They agreed that care was futile.  They agreed to remove life support on 11/12 and the patient succumbed to her disease process.  She passed and was pronounced at 5:46 p.m. on 11/12/2021."
	"1880333-1"	"1880333-1"	"PNEUMOTHORAX"	"10035759"	"65-79 years"	"65-79"	"patient now deceased.  Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization  DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia.  Resolved. 9. Hypocalcemia.  Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath.  She tested positive for COVID.  She was treated with Decadron, then Solu-Medrol, and remdesivir.  Unfortunately, the patient's clinical course deteriorated and she required intubation on 10/30.  Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate.  After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days.  It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy.  Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state.  They agreed that care was futile.  They agreed to remove life support on 11/12 and the patient succumbed to her disease process.  She passed and was pronounced at 5:46 p.m. on 11/12/2021."
	"1880333-1"	"1880333-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"patient now deceased.  Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization  DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia.  Resolved. 9. Hypocalcemia.  Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath.  She tested positive for COVID.  She was treated with Decadron, then Solu-Medrol, and remdesivir.  Unfortunately, the patient's clinical course deteriorated and she required intubation on 10/30.  Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate.  After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days.  It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy.  Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state.  They agreed that care was futile.  They agreed to remove life support on 11/12 and the patient succumbed to her disease process.  She passed and was pronounced at 5:46 p.m. on 11/12/2021."
	"1880333-1"	"1880333-1"	"TYPE 2 DIABETES MELLITUS"	"10067585"	"65-79 years"	"65-79"	"patient now deceased.  Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization  DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia.  Resolved. 9. Hypocalcemia.  Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath.  She tested positive for COVID.  She was treated with Decadron, then Solu-Medrol, and remdesivir.  Unfortunately, the patient's clinical course deteriorated and she required intubation on 10/30.  Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate.  After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days.  It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy.  Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state.  They agreed that care was futile.  They agreed to remove life support on 11/12 and the patient succumbed to her disease process.  She passed and was pronounced at 5:46 p.m. on 11/12/2021."
	"1880780-1"	"1880780-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"CHEST TUBE INSERTION"	"10050522"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"DEEP VEIN THROMBOSIS"	"10051055"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"ECHOCARDIOGRAM ABNORMAL"	"10061593"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"EJECTION FRACTION DECREASED"	"10050528"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"FRACTION OF INSPIRED OXYGEN"	"10059883"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"GASTROSTOMY"	"10048978"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"PNEUMONIA NECROTISING"	"10055672"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"PNEUMONIA PSEUDOMONAL"	"10035731"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"PNEUMOTHORAX"	"10035759"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"POSITIVE END-EXPIRATORY PRESSURE"	"10059890"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"PULMONARY EMBOLISM"	"10037377"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"PULSELESS ELECTRICAL ACTIVITY"	"10058151"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"RENAL TUBULAR NECROSIS"	"10038540"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"SEPSIS"	"10040047"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"TIDAL VOLUME"	"10076535"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880780-1"	"1880780-1"	"TRACHEOSTOMY"	"10044320"	"65-79 years"	"65-79"	"74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021.  Pt's son passed away from COVID-19 infection. The patient tested positive on 10/5/2021.  The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis.  The patient was given tocilizumab, remdesivir and steroids.  The patient's hospital course was further complicated by DVT and pulmonary embolism.  Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas.  Pt was seen and was on Meropenem.  Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021.  The patient's family met with palliative care and they wanted to continue current care.  On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%.  The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left.  Pt's condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at  that time.  Pt was placed on comfort cares and expired on 11/12/2021 at 1500."
	"1880787-1"	"1880787-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death less than 24 hours after vaccine."
	"1880901-1"	"1880901-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"ALANINE AMINOTRANSFERASE INCREASED"	"10001551"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"ANION GAP"	"10002522"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"AORTIC DILATATION"	"10057453"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"ASPARTATE AMINOTRANSFERASE INCREASED"	"10003481"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"BLOOD ALBUMIN DECREASED"	"10005287"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"BLOOD ALKALINE PHOSPHATASE INCREASED"	"10059570"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"BLOOD BICARBONATE INCREASED"	"10005360"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"BLOOD BILIRUBIN NORMAL"	"10005367"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"BLOOD CALCIUM NORMAL"	"10005397"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"BLOOD CHLORIDE NORMAL"	"10005421"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"BLOOD CREATININE INCREASED"	"10005483"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"BLOOD GLUCOSE INCREASED"	"10005557"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"BLOOD PH DECREASED"	"10005706"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"BLOOD POTASSIUM INCREASED"	"10005725"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"BLOOD SODIUM NORMAL"	"10005804"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"BLOOD UREA INCREASED"	"10005851"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"BRADYCARDIA"	"10006093"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"BUNDLE BRANCH BLOCK RIGHT"	"10006582"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"CARDIOMEGALY"	"10007632"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"CREATININE RENAL CLEARANCE INCREASED"	"10011364"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"DEPRESSED LEVEL OF CONSCIOUSNESS"	"10012373"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"ELECTROCARDIOGRAM ABNORMAL"	"10014363"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"ELECTROCARDIOGRAM QRS COMPLEX ABNORMAL"	"10014378"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"FIBRIN D DIMER INCREASED"	"10016581"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"FULL BLOOD COUNT ABNORMAL"	"10017412"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"GLOMERULAR FILTRATION RATE DECREASED"	"10018358"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"GRAM STAIN POSITIVE"	"10018656"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"HAEMATOCRIT NORMAL"	"10018842"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"HAEMOGLOBIN DECREASED"	"10018884"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"HYPERCAPNIA"	"10020591"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"LUNG OPACITY"	"10081792"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"MEAN CELL HAEMOGLOBIN CONCENTRATION DECREASED"	"10026991"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"MEAN CELL HAEMOGLOBIN NORMAL"	"10026997"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"MEAN CELL VOLUME INCREASED"	"10027004"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"MEAN PLATELET VOLUME INCREASED"	"10055052"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"METABOLIC FUNCTION TEST ABNORMAL"	"10061286"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"MYOCARDIAL INFARCTION"	"10028596"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"PCO2 INCREASED"	"10034183"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"PLATELET COUNT DECREASED"	"10035528"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"PLEURAL EFFUSION"	"10035598"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"PLEURAL THICKENING"	"10035616"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"POSITIVE AIRWAY PRESSURE THERAPY"	"10086397"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"PROTEIN TOTAL NORMAL"	"10037017"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"QRS AXIS ABNORMAL"	"10057624"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"RED BLOOD CELL COUNT DECREASED"	"10038153"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"RED BLOOD CELL NUCLEATED MORPHOLOGY"	"10080979"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"RED CELL DISTRIBUTION WIDTH NORMAL"	"10053922"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"RESPIRATORY FAILURE"	"10038695"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"SCOLIOSIS"	"10039722"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"SERUM FERRITIN INCREASED"	"10040250"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"STAPHYLOCOCCUS TEST POSITIVE"	"10070052"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"SUPRAVENTRICULAR TACHYCARDIA"	"10042604"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"TRACHEAL DEVIATION"	"10044287"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"VENTRICULAR EXTRASYSTOLES"	"10047289"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"VENTRICULAR FIBRILLATION"	"10047290"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1880901-1"	"1880901-1"	"WHITE BLOOD CELL COUNT NORMAL"	"10047944"	"65-79 years"	"65-79"	""""Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2  Discharge Disposition: Deceased   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02]   HOSPITAL COURSE: 73 yo male who is a resident of facility.  Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness.  He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status.  He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness.  He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP.  A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive.  In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis.  He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..""
	"1881273-1"	"1881273-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death - Symptoms unknown"
	"1885160-1"	"1885160-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Died 7 days after shot after shot had uncontrolled sugar levels  could not get sugar up and felt sick 2 days after and died 7days later"
	"1885160-1"	"1885160-1"	"DIABETES MELLITUS INADEQUATE CONTROL"	"10012607"	"65-79 years"	"65-79"	"Died 7 days after shot after shot had uncontrolled sugar levels  could not get sugar up and felt sick 2 days after and died 7days later"
	"1885160-1"	"1885160-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Died 7 days after shot after shot had uncontrolled sugar levels  could not get sugar up and felt sick 2 days after and died 7days later"
	"1890024-1"	"1890024-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Dose 1 Pfizer given 2/19/2021 lot # EN6203  Patient had a cardiac arrest at home and died in the emergency room."
	"1890024-1"	"1890024-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Dose 1 Pfizer given 2/19/2021 lot # EN6203  Patient had a cardiac arrest at home and died in the emergency room."
	"1890159-1"	"1890159-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"BLOOD CULTURE POSITIVE"	"10005488"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"BLOOD GASES ABNORMAL"	"10005539"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"BRONCHOSCOPY ABNORMAL"	"10006480"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"COMPUTERISED TOMOGRAM ABDOMEN NORMAL"	"10057800"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"COMPUTERISED TOMOGRAM HEAD NORMAL"	"10072167"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"COMPUTERISED TOMOGRAM THORAX NORMAL"	"10057801"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"FRACTION OF INSPIRED OXYGEN"	"10059883"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"HYPERCAPNIA"	"10020591"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"KLEBSIELLA INFECTION"	"10061259"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"LUNG DISORDER"	"10025082"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"PRONE POSITION"	"10074744"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"RESPIRATORY ACIDOSIS"	"10038661"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"SPUTUM CULTURE POSITIVE"	"10051612"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"STAPHYLOCOCCAL INFECTION"	"10058080"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890159-1"	"1890159-1"	"WHITE BLOOD CELL COUNT NORMAL"	"10047944"	"65-79 years"	"65-79"	"Patient is now deceased.   Date of Death: 11/4/21 Time of Death:  2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19  See prior VAERS submission from initial hospitalization: 685006  (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19).  No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids.  Sputum culture on 10/24 grew klebsiella  and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course.  Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated.  He was being considered for tracheostomy as he had been intubated for 2 weeks, however  this was limited by inability to tolerate lower vent settings.  He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2.  The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs >65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis.  Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family."
	"1890336-1"	"1890336-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"pt was previously submitted to VAERS on  11/9/2021, VAERS E report # 706662 Updating with pt death  11/21/2021 Principal Problem:   Cerebral Hemorrhage  Active Problems:   Debility   Atrial Fibrillation Paroxysmal    Transplant Renal    Loss Hearing Sensorineural   Medication Therapy Long Term Not Anticoagulant   Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29    Immunodeficiency Due To Drugs    Hypertension And Chronic Kidney Disease Stage 3   Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Nondominant Side    COVID-19 Infection   Acute Respiratory Failure With Hypoxia"
	"1890336-1"	"1890336-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"pt was previously submitted to VAERS on  11/9/2021, VAERS E report # 706662 Updating with pt death  11/21/2021 Principal Problem:   Cerebral Hemorrhage  Active Problems:   Debility   Atrial Fibrillation Paroxysmal    Transplant Renal    Loss Hearing Sensorineural   Medication Therapy Long Term Not Anticoagulant   Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29    Immunodeficiency Due To Drugs    Hypertension And Chronic Kidney Disease Stage 3   Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Nondominant Side    COVID-19 Infection   Acute Respiratory Failure With Hypoxia"
	"1890336-1"	"1890336-1"	"ATRIAL FIBRILLATION"	"10003658"	"65-79 years"	"65-79"	"pt was previously submitted to VAERS on  11/9/2021, VAERS E report # 706662 Updating with pt death  11/21/2021 Principal Problem:   Cerebral Hemorrhage  Active Problems:   Debility   Atrial Fibrillation Paroxysmal    Transplant Renal    Loss Hearing Sensorineural   Medication Therapy Long Term Not Anticoagulant   Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29    Immunodeficiency Due To Drugs    Hypertension And Chronic Kidney Disease Stage 3   Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Nondominant Side    COVID-19 Infection   Acute Respiratory Failure With Hypoxia"
	"1890336-1"	"1890336-1"	"CEREBRAL HAEMORRHAGE"	"10008111"	"65-79 years"	"65-79"	"pt was previously submitted to VAERS on  11/9/2021, VAERS E report # 706662 Updating with pt death  11/21/2021 Principal Problem:   Cerebral Hemorrhage  Active Problems:   Debility   Atrial Fibrillation Paroxysmal    Transplant Renal    Loss Hearing Sensorineural   Medication Therapy Long Term Not Anticoagulant   Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29    Immunodeficiency Due To Drugs    Hypertension And Chronic Kidney Disease Stage 3   Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Nondominant Side    COVID-19 Infection   Acute Respiratory Failure With Hypoxia"
	"1890336-1"	"1890336-1"	"CEREBRAL INFARCTION"	"10008118"	"65-79 years"	"65-79"	"pt was previously submitted to VAERS on  11/9/2021, VAERS E report # 706662 Updating with pt death  11/21/2021 Principal Problem:   Cerebral Hemorrhage  Active Problems:   Debility   Atrial Fibrillation Paroxysmal    Transplant Renal    Loss Hearing Sensorineural   Medication Therapy Long Term Not Anticoagulant   Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29    Immunodeficiency Due To Drugs    Hypertension And Chronic Kidney Disease Stage 3   Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Nondominant Side    COVID-19 Infection   Acute Respiratory Failure With Hypoxia"
	"1890336-1"	"1890336-1"	"CHRONIC KIDNEY DISEASE"	"10064848"	"65-79 years"	"65-79"	"pt was previously submitted to VAERS on  11/9/2021, VAERS E report # 706662 Updating with pt death  11/21/2021 Principal Problem:   Cerebral Hemorrhage  Active Problems:   Debility   Atrial Fibrillation Paroxysmal    Transplant Renal    Loss Hearing Sensorineural   Medication Therapy Long Term Not Anticoagulant   Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29    Immunodeficiency Due To Drugs    Hypertension And Chronic Kidney Disease Stage 3   Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Nondominant Side    COVID-19 Infection   Acute Respiratory Failure With Hypoxia"
	"1890336-1"	"1890336-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"pt was previously submitted to VAERS on  11/9/2021, VAERS E report # 706662 Updating with pt death  11/21/2021 Principal Problem:   Cerebral Hemorrhage  Active Problems:   Debility   Atrial Fibrillation Paroxysmal    Transplant Renal    Loss Hearing Sensorineural   Medication Therapy Long Term Not Anticoagulant   Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29    Immunodeficiency Due To Drugs    Hypertension And Chronic Kidney Disease Stage 3   Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Nondominant Side    COVID-19 Infection   Acute Respiratory Failure With Hypoxia"
	"1890336-1"	"1890336-1"	"DEAFNESS NEUROSENSORY"	"10011891"	"65-79 years"	"65-79"	"pt was previously submitted to VAERS on  11/9/2021, VAERS E report # 706662 Updating with pt death  11/21/2021 Principal Problem:   Cerebral Hemorrhage  Active Problems:   Debility   Atrial Fibrillation Paroxysmal    Transplant Renal    Loss Hearing Sensorineural   Medication Therapy Long Term Not Anticoagulant   Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29    Immunodeficiency Due To Drugs    Hypertension And Chronic Kidney Disease Stage 3   Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Nondominant Side    COVID-19 Infection   Acute Respiratory Failure With Hypoxia"
	"1890336-1"	"1890336-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"pt was previously submitted to VAERS on  11/9/2021, VAERS E report # 706662 Updating with pt death  11/21/2021 Principal Problem:   Cerebral Hemorrhage  Active Problems:   Debility   Atrial Fibrillation Paroxysmal    Transplant Renal    Loss Hearing Sensorineural   Medication Therapy Long Term Not Anticoagulant   Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29    Immunodeficiency Due To Drugs    Hypertension And Chronic Kidney Disease Stage 3   Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Nondominant Side    COVID-19 Infection   Acute Respiratory Failure With Hypoxia"
	"1890336-1"	"1890336-1"	"GLOMERULAR FILTRATION RATE"	"10018355"	"65-79 years"	"65-79"	"pt was previously submitted to VAERS on  11/9/2021, VAERS E report # 706662 Updating with pt death  11/21/2021 Principal Problem:   Cerebral Hemorrhage  Active Problems:   Debility   Atrial Fibrillation Paroxysmal    Transplant Renal    Loss Hearing Sensorineural   Medication Therapy Long Term Not Anticoagulant   Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29    Immunodeficiency Due To Drugs    Hypertension And Chronic Kidney Disease Stage 3   Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Nondominant Side    COVID-19 Infection   Acute Respiratory Failure With Hypoxia"
	"1890336-1"	"1890336-1"	"HEMIPARESIS"	"10019465"	"65-79 years"	"65-79"	"pt was previously submitted to VAERS on  11/9/2021, VAERS E report # 706662 Updating with pt death  11/21/2021 Principal Problem:   Cerebral Hemorrhage  Active Problems:   Debility   Atrial Fibrillation Paroxysmal    Transplant Renal    Loss Hearing Sensorineural   Medication Therapy Long Term Not Anticoagulant   Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29    Immunodeficiency Due To Drugs    Hypertension And Chronic Kidney Disease Stage 3   Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Nondominant Side    COVID-19 Infection   Acute Respiratory Failure With Hypoxia"
	"1890336-1"	"1890336-1"	"HEMIPLEGIA"	"10019468"	"65-79 years"	"65-79"	"pt was previously submitted to VAERS on  11/9/2021, VAERS E report # 706662 Updating with pt death  11/21/2021 Principal Problem:   Cerebral Hemorrhage  Active Problems:   Debility   Atrial Fibrillation Paroxysmal    Transplant Renal    Loss Hearing Sensorineural   Medication Therapy Long Term Not Anticoagulant   Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29    Immunodeficiency Due To Drugs    Hypertension And Chronic Kidney Disease Stage 3   Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Nondominant Side    COVID-19 Infection   Acute Respiratory Failure With Hypoxia"
	"1890336-1"	"1890336-1"	"HYPERTENSION"	"10020772"	"65-79 years"	"65-79"	"pt was previously submitted to VAERS on  11/9/2021, VAERS E report # 706662 Updating with pt death  11/21/2021 Principal Problem:   Cerebral Hemorrhage  Active Problems:   Debility   Atrial Fibrillation Paroxysmal    Transplant Renal    Loss Hearing Sensorineural   Medication Therapy Long Term Not Anticoagulant   Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29    Immunodeficiency Due To Drugs    Hypertension And Chronic Kidney Disease Stage 3   Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Nondominant Side    COVID-19 Infection   Acute Respiratory Failure With Hypoxia"
	"1890336-1"	"1890336-1"	"IMMUNODEFICIENCY"	"10061598"	"65-79 years"	"65-79"	"pt was previously submitted to VAERS on  11/9/2021, VAERS E report # 706662 Updating with pt death  11/21/2021 Principal Problem:   Cerebral Hemorrhage  Active Problems:   Debility   Atrial Fibrillation Paroxysmal    Transplant Renal    Loss Hearing Sensorineural   Medication Therapy Long Term Not Anticoagulant   Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29    Immunodeficiency Due To Drugs    Hypertension And Chronic Kidney Disease Stage 3   Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Nondominant Side    COVID-19 Infection   Acute Respiratory Failure With Hypoxia"
	"1890336-1"	"1890336-1"	"RENAL TRANSPLANT"	"10038533"	"65-79 years"	"65-79"	"pt was previously submitted to VAERS on  11/9/2021, VAERS E report # 706662 Updating with pt death  11/21/2021 Principal Problem:   Cerebral Hemorrhage  Active Problems:   Debility   Atrial Fibrillation Paroxysmal    Transplant Renal    Loss Hearing Sensorineural   Medication Therapy Long Term Not Anticoagulant   Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29    Immunodeficiency Due To Drugs    Hypertension And Chronic Kidney Disease Stage 3   Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Nondominant Side    COVID-19 Infection   Acute Respiratory Failure With Hypoxia"
	"1894216-1"	"1894216-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"SOB resp failure"
	"1894216-1"	"1894216-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"SOB resp failure"
	"1894216-1"	"1894216-1"	"RESPIRATORY FAILURE"	"10038695"	"65-79 years"	"65-79"	"SOB resp failure"
	"1894216-1"	"1894216-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"SOB resp failure"
	"1897283-1"	"1897283-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"patient passed away and was found dead over a day after receiving the vaccine; expiration date of vaccine 11/25/21; patient received this as a booster dose he had first and second dose in the Spring"
	"1897353-1"	"1897353-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death; was hospice and was declining prior to vaccination"
	"1899499-1"	"1899499-1"	"ANTICOAGULANT THERAPY"	"10053468"	"65-79 years"	"65-79"	"Patient is now deceased.  ED 11.20.21; hospitalized 11.21.21; COVID-19 positive (11.20.21);  fully vaccinated Admitted for hypotension, septic shock, COVID-19 (with ESRD, cardiomyopathy, bilateral PE) Admission Date: 11/21/2021 Date of Death: 11/23/21 Time of Death: 12:59 PM Preliminary Cause of Death: Hypotension DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shock (HCC) [R57.9] Hypotension [I95.9] HOSPITAL COURSE: This is a 77 year old male with a PMH significant for HTN, HLD, ESRD on HD, T2DM with retinopathy & neuropathy, gout, hemochromatosis, hyperparathyroidism, cardiomyopathy, OSA on BiPAP, CAD and obesity who was brought to the emergency department on 11/20 by EMS from his care facility with concerns of hypotension. The patient was noted to be hypotensive on initial evaluation and was given Levophed, also found to be positive for COVID-19 and noted to have CT thorax findings of large right effusion unchanged from prior imaging, increasing moderate left effusion, as well as patchy airspace disease in the right upper lobe and right middle lob suggestive of pneumonia representative of changes secondary to COVID-19 with inflammatory changes and early bacterial pneumonia. There was also question about the possibility of a PE on the CT thorax, however it was deemed unlikely as the patient had been anticoagulated with Warfarin for Atrial Fibrillation with therapeutic INR. The patient was started on broad spectrum antibiotics for bacterial pneumonia and was started on Remdesivir and Decadron for treatment of COVID-19 with admission for further evaluation and management. On the first full day after his ER visit that led to admission, the patient had elected not to pursue treatments any further. Hospice was consulted and patient/patient's family ultimately elected for inpatient hospice. Nephrology had been consulted for assistance with the patient's dialysis, although they ultimately signed off the patient's care due to patient choosing not to pursue further treatment and deciding to pursue inpatient hospice care. During the patient's hospitalization, his ICD was turned off given the patient's decision for hospice care. The patient was kept comfortable with the help of hospice during the remainder of his hospitalization and he expired comfortably on 11/23/21 with his wife and son at bedside. The patient was pronounced expired at 12:59PM on 11/23/21."
	"1899499-1"	"1899499-1"	"CARDIOMYOPATHY"	"10007636"	"65-79 years"	"65-79"	"Patient is now deceased.  ED 11.20.21; hospitalized 11.21.21; COVID-19 positive (11.20.21);  fully vaccinated Admitted for hypotension, septic shock, COVID-19 (with ESRD, cardiomyopathy, bilateral PE) Admission Date: 11/21/2021 Date of Death: 11/23/21 Time of Death: 12:59 PM Preliminary Cause of Death: Hypotension DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shock (HCC) [R57.9] Hypotension [I95.9] HOSPITAL COURSE: This is a 77 year old male with a PMH significant for HTN, HLD, ESRD on HD, T2DM with retinopathy & neuropathy, gout, hemochromatosis, hyperparathyroidism, cardiomyopathy, OSA on BiPAP, CAD and obesity who was brought to the emergency department on 11/20 by EMS from his care facility with concerns of hypotension. The patient was noted to be hypotensive on initial evaluation and was given Levophed, also found to be positive for COVID-19 and noted to have CT thorax findings of large right effusion unchanged from prior imaging, increasing moderate left effusion, as well as patchy airspace disease in the right upper lobe and right middle lob suggestive of pneumonia representative of changes secondary to COVID-19 with inflammatory changes and early bacterial pneumonia. There was also question about the possibility of a PE on the CT thorax, however it was deemed unlikely as the patient had been anticoagulated with Warfarin for Atrial Fibrillation with therapeutic INR. The patient was started on broad spectrum antibiotics for bacterial pneumonia and was started on Remdesivir and Decadron for treatment of COVID-19 with admission for further evaluation and management. On the first full day after his ER visit that led to admission, the patient had elected not to pursue treatments any further. Hospice was consulted and patient/patient's family ultimately elected for inpatient hospice. Nephrology had been consulted for assistance with the patient's dialysis, although they ultimately signed off the patient's care due to patient choosing not to pursue further treatment and deciding to pursue inpatient hospice care. During the patient's hospitalization, his ICD was turned off given the patient's decision for hospice care. The patient was kept comfortable with the help of hospice during the remainder of his hospitalization and he expired comfortably on 11/23/21 with his wife and son at bedside. The patient was pronounced expired at 12:59PM on 11/23/21."
	"1899499-1"	"1899499-1"	"COMPUTERISED TOMOGRAM THORAX ABNORMAL"	"10057799"	"65-79 years"	"65-79"	"Patient is now deceased.  ED 11.20.21; hospitalized 11.21.21; COVID-19 positive (11.20.21);  fully vaccinated Admitted for hypotension, septic shock, COVID-19 (with ESRD, cardiomyopathy, bilateral PE) Admission Date: 11/21/2021 Date of Death: 11/23/21 Time of Death: 12:59 PM Preliminary Cause of Death: Hypotension DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shock (HCC) [R57.9] Hypotension [I95.9] HOSPITAL COURSE: This is a 77 year old male with a PMH significant for HTN, HLD, ESRD on HD, T2DM with retinopathy & neuropathy, gout, hemochromatosis, hyperparathyroidism, cardiomyopathy, OSA on BiPAP, CAD and obesity who was brought to the emergency department on 11/20 by EMS from his care facility with concerns of hypotension. The patient was noted to be hypotensive on initial evaluation and was given Levophed, also found to be positive for COVID-19 and noted to have CT thorax findings of large right effusion unchanged from prior imaging, increasing moderate left effusion, as well as patchy airspace disease in the right upper lobe and right middle lob suggestive of pneumonia representative of changes secondary to COVID-19 with inflammatory changes and early bacterial pneumonia. There was also question about the possibility of a PE on the CT thorax, however it was deemed unlikely as the patient had been anticoagulated with Warfarin for Atrial Fibrillation with therapeutic INR. The patient was started on broad spectrum antibiotics for bacterial pneumonia and was started on Remdesivir and Decadron for treatment of COVID-19 with admission for further evaluation and management. On the first full day after his ER visit that led to admission, the patient had elected not to pursue treatments any further. Hospice was consulted and patient/patient's family ultimately elected for inpatient hospice. Nephrology had been consulted for assistance with the patient's dialysis, although they ultimately signed off the patient's care due to patient choosing not to pursue further treatment and deciding to pursue inpatient hospice care. During the patient's hospitalization, his ICD was turned off given the patient's decision for hospice care. The patient was kept comfortable with the help of hospice during the remainder of his hospitalization and he expired comfortably on 11/23/21 with his wife and son at bedside. The patient was pronounced expired at 12:59PM on 11/23/21."
	"1899499-1"	"1899499-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Patient is now deceased.  ED 11.20.21; hospitalized 11.21.21; COVID-19 positive (11.20.21);  fully vaccinated Admitted for hypotension, septic shock, COVID-19 (with ESRD, cardiomyopathy, bilateral PE) Admission Date: 11/21/2021 Date of Death: 11/23/21 Time of Death: 12:59 PM Preliminary Cause of Death: Hypotension DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shock (HCC) [R57.9] Hypotension [I95.9] HOSPITAL COURSE: This is a 77 year old male with a PMH significant for HTN, HLD, ESRD on HD, T2DM with retinopathy & neuropathy, gout, hemochromatosis, hyperparathyroidism, cardiomyopathy, OSA on BiPAP, CAD and obesity who was brought to the emergency department on 11/20 by EMS from his care facility with concerns of hypotension. The patient was noted to be hypotensive on initial evaluation and was given Levophed, also found to be positive for COVID-19 and noted to have CT thorax findings of large right effusion unchanged from prior imaging, increasing moderate left effusion, as well as patchy airspace disease in the right upper lobe and right middle lob suggestive of pneumonia representative of changes secondary to COVID-19 with inflammatory changes and early bacterial pneumonia. There was also question about the possibility of a PE on the CT thorax, however it was deemed unlikely as the patient had been anticoagulated with Warfarin for Atrial Fibrillation with therapeutic INR. The patient was started on broad spectrum antibiotics for bacterial pneumonia and was started on Remdesivir and Decadron for treatment of COVID-19 with admission for further evaluation and management. On the first full day after his ER visit that led to admission, the patient had elected not to pursue treatments any further. Hospice was consulted and patient/patient's family ultimately elected for inpatient hospice. Nephrology had been consulted for assistance with the patient's dialysis, although they ultimately signed off the patient's care due to patient choosing not to pursue further treatment and deciding to pursue inpatient hospice care. During the patient's hospitalization, his ICD was turned off given the patient's decision for hospice care. The patient was kept comfortable with the help of hospice during the remainder of his hospitalization and he expired comfortably on 11/23/21 with his wife and son at bedside. The patient was pronounced expired at 12:59PM on 11/23/21."
	"1899499-1"	"1899499-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient is now deceased.  ED 11.20.21; hospitalized 11.21.21; COVID-19 positive (11.20.21);  fully vaccinated Admitted for hypotension, septic shock, COVID-19 (with ESRD, cardiomyopathy, bilateral PE) Admission Date: 11/21/2021 Date of Death: 11/23/21 Time of Death: 12:59 PM Preliminary Cause of Death: Hypotension DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shock (HCC) [R57.9] Hypotension [I95.9] HOSPITAL COURSE: This is a 77 year old male with a PMH significant for HTN, HLD, ESRD on HD, T2DM with retinopathy & neuropathy, gout, hemochromatosis, hyperparathyroidism, cardiomyopathy, OSA on BiPAP, CAD and obesity who was brought to the emergency department on 11/20 by EMS from his care facility with concerns of hypotension. The patient was noted to be hypotensive on initial evaluation and was given Levophed, also found to be positive for COVID-19 and noted to have CT thorax findings of large right effusion unchanged from prior imaging, increasing moderate left effusion, as well as patchy airspace disease in the right upper lobe and right middle lob suggestive of pneumonia representative of changes secondary to COVID-19 with inflammatory changes and early bacterial pneumonia. There was also question about the possibility of a PE on the CT thorax, however it was deemed unlikely as the patient had been anticoagulated with Warfarin for Atrial Fibrillation with therapeutic INR. The patient was started on broad spectrum antibiotics for bacterial pneumonia and was started on Remdesivir and Decadron for treatment of COVID-19 with admission for further evaluation and management. On the first full day after his ER visit that led to admission, the patient had elected not to pursue treatments any further. Hospice was consulted and patient/patient's family ultimately elected for inpatient hospice. Nephrology had been consulted for assistance with the patient's dialysis, although they ultimately signed off the patient's care due to patient choosing not to pursue further treatment and deciding to pursue inpatient hospice care. During the patient's hospitalization, his ICD was turned off given the patient's decision for hospice care. The patient was kept comfortable with the help of hospice during the remainder of his hospitalization and he expired comfortably on 11/23/21 with his wife and son at bedside. The patient was pronounced expired at 12:59PM on 11/23/21."
	"1899499-1"	"1899499-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient is now deceased.  ED 11.20.21; hospitalized 11.21.21; COVID-19 positive (11.20.21);  fully vaccinated Admitted for hypotension, septic shock, COVID-19 (with ESRD, cardiomyopathy, bilateral PE) Admission Date: 11/21/2021 Date of Death: 11/23/21 Time of Death: 12:59 PM Preliminary Cause of Death: Hypotension DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shock (HCC) [R57.9] Hypotension [I95.9] HOSPITAL COURSE: This is a 77 year old male with a PMH significant for HTN, HLD, ESRD on HD, T2DM with retinopathy & neuropathy, gout, hemochromatosis, hyperparathyroidism, cardiomyopathy, OSA on BiPAP, CAD and obesity who was brought to the emergency department on 11/20 by EMS from his care facility with concerns of hypotension. The patient was noted to be hypotensive on initial evaluation and was given Levophed, also found to be positive for COVID-19 and noted to have CT thorax findings of large right effusion unchanged from prior imaging, increasing moderate left effusion, as well as patchy airspace disease in the right upper lobe and right middle lob suggestive of pneumonia representative of changes secondary to COVID-19 with inflammatory changes and early bacterial pneumonia. There was also question about the possibility of a PE on the CT thorax, however it was deemed unlikely as the patient had been anticoagulated with Warfarin for Atrial Fibrillation with therapeutic INR. The patient was started on broad spectrum antibiotics for bacterial pneumonia and was started on Remdesivir and Decadron for treatment of COVID-19 with admission for further evaluation and management. On the first full day after his ER visit that led to admission, the patient had elected not to pursue treatments any further. Hospice was consulted and patient/patient's family ultimately elected for inpatient hospice. Nephrology had been consulted for assistance with the patient's dialysis, although they ultimately signed off the patient's care due to patient choosing not to pursue further treatment and deciding to pursue inpatient hospice care. During the patient's hospitalization, his ICD was turned off given the patient's decision for hospice care. The patient was kept comfortable with the help of hospice during the remainder of his hospitalization and he expired comfortably on 11/23/21 with his wife and son at bedside. The patient was pronounced expired at 12:59PM on 11/23/21."
	"1899499-1"	"1899499-1"	"END STAGE RENAL DISEASE"	"10077512"	"65-79 years"	"65-79"	"Patient is now deceased.  ED 11.20.21; hospitalized 11.21.21; COVID-19 positive (11.20.21);  fully vaccinated Admitted for hypotension, septic shock, COVID-19 (with ESRD, cardiomyopathy, bilateral PE) Admission Date: 11/21/2021 Date of Death: 11/23/21 Time of Death: 12:59 PM Preliminary Cause of Death: Hypotension DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shock (HCC) [R57.9] Hypotension [I95.9] HOSPITAL COURSE: This is a 77 year old male with a PMH significant for HTN, HLD, ESRD on HD, T2DM with retinopathy & neuropathy, gout, hemochromatosis, hyperparathyroidism, cardiomyopathy, OSA on BiPAP, CAD and obesity who was brought to the emergency department on 11/20 by EMS from his care facility with concerns of hypotension. The patient was noted to be hypotensive on initial evaluation and was given Levophed, also found to be positive for COVID-19 and noted to have CT thorax findings of large right effusion unchanged from prior imaging, increasing moderate left effusion, as well as patchy airspace disease in the right upper lobe and right middle lob suggestive of pneumonia representative of changes secondary to COVID-19 with inflammatory changes and early bacterial pneumonia. There was also question about the possibility of a PE on the CT thorax, however it was deemed unlikely as the patient had been anticoagulated with Warfarin for Atrial Fibrillation with therapeutic INR. The patient was started on broad spectrum antibiotics for bacterial pneumonia and was started on Remdesivir and Decadron for treatment of COVID-19 with admission for further evaluation and management. On the first full day after his ER visit that led to admission, the patient had elected not to pursue treatments any further. Hospice was consulted and patient/patient's family ultimately elected for inpatient hospice. Nephrology had been consulted for assistance with the patient's dialysis, although they ultimately signed off the patient's care due to patient choosing not to pursue further treatment and deciding to pursue inpatient hospice care. During the patient's hospitalization, his ICD was turned off given the patient's decision for hospice care. The patient was kept comfortable with the help of hospice during the remainder of his hospitalization and he expired comfortably on 11/23/21 with his wife and son at bedside. The patient was pronounced expired at 12:59PM on 11/23/21."
	"1899499-1"	"1899499-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	"Patient is now deceased.  ED 11.20.21; hospitalized 11.21.21; COVID-19 positive (11.20.21);  fully vaccinated Admitted for hypotension, septic shock, COVID-19 (with ESRD, cardiomyopathy, bilateral PE) Admission Date: 11/21/2021 Date of Death: 11/23/21 Time of Death: 12:59 PM Preliminary Cause of Death: Hypotension DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shock (HCC) [R57.9] Hypotension [I95.9] HOSPITAL COURSE: This is a 77 year old male with a PMH significant for HTN, HLD, ESRD on HD, T2DM with retinopathy & neuropathy, gout, hemochromatosis, hyperparathyroidism, cardiomyopathy, OSA on BiPAP, CAD and obesity who was brought to the emergency department on 11/20 by EMS from his care facility with concerns of hypotension. The patient was noted to be hypotensive on initial evaluation and was given Levophed, also found to be positive for COVID-19 and noted to have CT thorax findings of large right effusion unchanged from prior imaging, increasing moderate left effusion, as well as patchy airspace disease in the right upper lobe and right middle lob suggestive of pneumonia representative of changes secondary to COVID-19 with inflammatory changes and early bacterial pneumonia. There was also question about the possibility of a PE on the CT thorax, however it was deemed unlikely as the patient had been anticoagulated with Warfarin for Atrial Fibrillation with therapeutic INR. The patient was started on broad spectrum antibiotics for bacterial pneumonia and was started on Remdesivir and Decadron for treatment of COVID-19 with admission for further evaluation and management. On the first full day after his ER visit that led to admission, the patient had elected not to pursue treatments any further. Hospice was consulted and patient/patient's family ultimately elected for inpatient hospice. Nephrology had been consulted for assistance with the patient's dialysis, although they ultimately signed off the patient's care due to patient choosing not to pursue further treatment and deciding to pursue inpatient hospice care. During the patient's hospitalization, his ICD was turned off given the patient's decision for hospice care. The patient was kept comfortable with the help of hospice during the remainder of his hospitalization and he expired comfortably on 11/23/21 with his wife and son at bedside. The patient was pronounced expired at 12:59PM on 11/23/21."
	"1899499-1"	"1899499-1"	"PLEURAL EFFUSION"	"10035598"	"65-79 years"	"65-79"	"Patient is now deceased.  ED 11.20.21; hospitalized 11.21.21; COVID-19 positive (11.20.21);  fully vaccinated Admitted for hypotension, septic shock, COVID-19 (with ESRD, cardiomyopathy, bilateral PE) Admission Date: 11/21/2021 Date of Death: 11/23/21 Time of Death: 12:59 PM Preliminary Cause of Death: Hypotension DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shock (HCC) [R57.9] Hypotension [I95.9] HOSPITAL COURSE: This is a 77 year old male with a PMH significant for HTN, HLD, ESRD on HD, T2DM with retinopathy & neuropathy, gout, hemochromatosis, hyperparathyroidism, cardiomyopathy, OSA on BiPAP, CAD and obesity who was brought to the emergency department on 11/20 by EMS from his care facility with concerns of hypotension. The patient was noted to be hypotensive on initial evaluation and was given Levophed, also found to be positive for COVID-19 and noted to have CT thorax findings of large right effusion unchanged from prior imaging, increasing moderate left effusion, as well as patchy airspace disease in the right upper lobe and right middle lob suggestive of pneumonia representative of changes secondary to COVID-19 with inflammatory changes and early bacterial pneumonia. There was also question about the possibility of a PE on the CT thorax, however it was deemed unlikely as the patient had been anticoagulated with Warfarin for Atrial Fibrillation with therapeutic INR. The patient was started on broad spectrum antibiotics for bacterial pneumonia and was started on Remdesivir and Decadron for treatment of COVID-19 with admission for further evaluation and management. On the first full day after his ER visit that led to admission, the patient had elected not to pursue treatments any further. Hospice was consulted and patient/patient's family ultimately elected for inpatient hospice. Nephrology had been consulted for assistance with the patient's dialysis, although they ultimately signed off the patient's care due to patient choosing not to pursue further treatment and deciding to pursue inpatient hospice care. During the patient's hospitalization, his ICD was turned off given the patient's decision for hospice care. The patient was kept comfortable with the help of hospice during the remainder of his hospitalization and he expired comfortably on 11/23/21 with his wife and son at bedside. The patient was pronounced expired at 12:59PM on 11/23/21."
	"1899499-1"	"1899499-1"	"PNEUMONIA BACTERIAL"	"10060946"	"65-79 years"	"65-79"	"Patient is now deceased.  ED 11.20.21; hospitalized 11.21.21; COVID-19 positive (11.20.21);  fully vaccinated Admitted for hypotension, septic shock, COVID-19 (with ESRD, cardiomyopathy, bilateral PE) Admission Date: 11/21/2021 Date of Death: 11/23/21 Time of Death: 12:59 PM Preliminary Cause of Death: Hypotension DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shock (HCC) [R57.9] Hypotension [I95.9] HOSPITAL COURSE: This is a 77 year old male with a PMH significant for HTN, HLD, ESRD on HD, T2DM with retinopathy & neuropathy, gout, hemochromatosis, hyperparathyroidism, cardiomyopathy, OSA on BiPAP, CAD and obesity who was brought to the emergency department on 11/20 by EMS from his care facility with concerns of hypotension. The patient was noted to be hypotensive on initial evaluation and was given Levophed, also found to be positive for COVID-19 and noted to have CT thorax findings of large right effusion unchanged from prior imaging, increasing moderate left effusion, as well as patchy airspace disease in the right upper lobe and right middle lob suggestive of pneumonia representative of changes secondary to COVID-19 with inflammatory changes and early bacterial pneumonia. There was also question about the possibility of a PE on the CT thorax, however it was deemed unlikely as the patient had been anticoagulated with Warfarin for Atrial Fibrillation with therapeutic INR. The patient was started on broad spectrum antibiotics for bacterial pneumonia and was started on Remdesivir and Decadron for treatment of COVID-19 with admission for further evaluation and management. On the first full day after his ER visit that led to admission, the patient had elected not to pursue treatments any further. Hospice was consulted and patient/patient's family ultimately elected for inpatient hospice. Nephrology had been consulted for assistance with the patient's dialysis, although they ultimately signed off the patient's care due to patient choosing not to pursue further treatment and deciding to pursue inpatient hospice care. During the patient's hospitalization, his ICD was turned off given the patient's decision for hospice care. The patient was kept comfortable with the help of hospice during the remainder of his hospitalization and he expired comfortably on 11/23/21 with his wife and son at bedside. The patient was pronounced expired at 12:59PM on 11/23/21."
	"1899499-1"	"1899499-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient is now deceased.  ED 11.20.21; hospitalized 11.21.21; COVID-19 positive (11.20.21);  fully vaccinated Admitted for hypotension, septic shock, COVID-19 (with ESRD, cardiomyopathy, bilateral PE) Admission Date: 11/21/2021 Date of Death: 11/23/21 Time of Death: 12:59 PM Preliminary Cause of Death: Hypotension DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shock (HCC) [R57.9] Hypotension [I95.9] HOSPITAL COURSE: This is a 77 year old male with a PMH significant for HTN, HLD, ESRD on HD, T2DM with retinopathy & neuropathy, gout, hemochromatosis, hyperparathyroidism, cardiomyopathy, OSA on BiPAP, CAD and obesity who was brought to the emergency department on 11/20 by EMS from his care facility with concerns of hypotension. The patient was noted to be hypotensive on initial evaluation and was given Levophed, also found to be positive for COVID-19 and noted to have CT thorax findings of large right effusion unchanged from prior imaging, increasing moderate left effusion, as well as patchy airspace disease in the right upper lobe and right middle lob suggestive of pneumonia representative of changes secondary to COVID-19 with inflammatory changes and early bacterial pneumonia. There was also question about the possibility of a PE on the CT thorax, however it was deemed unlikely as the patient had been anticoagulated with Warfarin for Atrial Fibrillation with therapeutic INR. The patient was started on broad spectrum antibiotics for bacterial pneumonia and was started on Remdesivir and Decadron for treatment of COVID-19 with admission for further evaluation and management. On the first full day after his ER visit that led to admission, the patient had elected not to pursue treatments any further. Hospice was consulted and patient/patient's family ultimately elected for inpatient hospice. Nephrology had been consulted for assistance with the patient's dialysis, although they ultimately signed off the patient's care due to patient choosing not to pursue further treatment and deciding to pursue inpatient hospice care. During the patient's hospitalization, his ICD was turned off given the patient's decision for hospice care. The patient was kept comfortable with the help of hospice during the remainder of his hospitalization and he expired comfortably on 11/23/21 with his wife and son at bedside. The patient was pronounced expired at 12:59PM on 11/23/21."
	"1899499-1"	"1899499-1"	"SEPTIC SHOCK"	"10040070"	"65-79 years"	"65-79"	"Patient is now deceased.  ED 11.20.21; hospitalized 11.21.21; COVID-19 positive (11.20.21);  fully vaccinated Admitted for hypotension, septic shock, COVID-19 (with ESRD, cardiomyopathy, bilateral PE) Admission Date: 11/21/2021 Date of Death: 11/23/21 Time of Death: 12:59 PM Preliminary Cause of Death: Hypotension DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shock (HCC) [R57.9] Hypotension [I95.9] HOSPITAL COURSE: This is a 77 year old male with a PMH significant for HTN, HLD, ESRD on HD, T2DM with retinopathy & neuropathy, gout, hemochromatosis, hyperparathyroidism, cardiomyopathy, OSA on BiPAP, CAD and obesity who was brought to the emergency department on 11/20 by EMS from his care facility with concerns of hypotension. The patient was noted to be hypotensive on initial evaluation and was given Levophed, also found to be positive for COVID-19 and noted to have CT thorax findings of large right effusion unchanged from prior imaging, increasing moderate left effusion, as well as patchy airspace disease in the right upper lobe and right middle lob suggestive of pneumonia representative of changes secondary to COVID-19 with inflammatory changes and early bacterial pneumonia. There was also question about the possibility of a PE on the CT thorax, however it was deemed unlikely as the patient had been anticoagulated with Warfarin for Atrial Fibrillation with therapeutic INR. The patient was started on broad spectrum antibiotics for bacterial pneumonia and was started on Remdesivir and Decadron for treatment of COVID-19 with admission for further evaluation and management. On the first full day after his ER visit that led to admission, the patient had elected not to pursue treatments any further. Hospice was consulted and patient/patient's family ultimately elected for inpatient hospice. Nephrology had been consulted for assistance with the patient's dialysis, although they ultimately signed off the patient's care due to patient choosing not to pursue further treatment and deciding to pursue inpatient hospice care. During the patient's hospitalization, his ICD was turned off given the patient's decision for hospice care. The patient was kept comfortable with the help of hospice during the remainder of his hospitalization and he expired comfortably on 11/23/21 with his wife and son at bedside. The patient was pronounced expired at 12:59PM on 11/23/21."
	"1899499-1"	"1899499-1"	"SHOCK"	"10040560"	"65-79 years"	"65-79"	"Patient is now deceased.  ED 11.20.21; hospitalized 11.21.21; COVID-19 positive (11.20.21);  fully vaccinated Admitted for hypotension, septic shock, COVID-19 (with ESRD, cardiomyopathy, bilateral PE) Admission Date: 11/21/2021 Date of Death: 11/23/21 Time of Death: 12:59 PM Preliminary Cause of Death: Hypotension DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shock (HCC) [R57.9] Hypotension [I95.9] HOSPITAL COURSE: This is a 77 year old male with a PMH significant for HTN, HLD, ESRD on HD, T2DM with retinopathy & neuropathy, gout, hemochromatosis, hyperparathyroidism, cardiomyopathy, OSA on BiPAP, CAD and obesity who was brought to the emergency department on 11/20 by EMS from his care facility with concerns of hypotension. The patient was noted to be hypotensive on initial evaluation and was given Levophed, also found to be positive for COVID-19 and noted to have CT thorax findings of large right effusion unchanged from prior imaging, increasing moderate left effusion, as well as patchy airspace disease in the right upper lobe and right middle lob suggestive of pneumonia representative of changes secondary to COVID-19 with inflammatory changes and early bacterial pneumonia. There was also question about the possibility of a PE on the CT thorax, however it was deemed unlikely as the patient had been anticoagulated with Warfarin for Atrial Fibrillation with therapeutic INR. The patient was started on broad spectrum antibiotics for bacterial pneumonia and was started on Remdesivir and Decadron for treatment of COVID-19 with admission for further evaluation and management. On the first full day after his ER visit that led to admission, the patient had elected not to pursue treatments any further. Hospice was consulted and patient/patient's family ultimately elected for inpatient hospice. Nephrology had been consulted for assistance with the patient's dialysis, although they ultimately signed off the patient's care due to patient choosing not to pursue further treatment and deciding to pursue inpatient hospice care. During the patient's hospitalization, his ICD was turned off given the patient's decision for hospice care. The patient was kept comfortable with the help of hospice during the remainder of his hospitalization and he expired comfortably on 11/23/21 with his wife and son at bedside. The patient was pronounced expired at 12:59PM on 11/23/21."
	"1905409-1"	"1905409-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Dose 1 given 2/5/2021 Moderna lot # 016M20A  Patient died of Covid 19 pneumonia, respiratory failure"
	"1905409-1"	"1905409-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Dose 1 given 2/5/2021 Moderna lot # 016M20A  Patient died of Covid 19 pneumonia, respiratory failure"
	"1905409-1"	"1905409-1"	"RESPIRATORY FAILURE"	"10038695"	"65-79 years"	"65-79"	"Dose 1 given 2/5/2021 Moderna lot # 016M20A  Patient died of Covid 19 pneumonia, respiratory failure"
	"1905445-1"	"1905445-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Dose 1 given 2/25/2021 Pfizer Lot # EN6198  Patient died from Covid 19"
	"1905445-1"	"1905445-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Dose 1 given 2/25/2021 Pfizer Lot # EN6198  Patient died from Covid 19"
	"1905460-1"	"1905460-1"	"CARDIAC FAILURE"	"10007554"	"65-79 years"	"65-79"	"Dose 1 Moderna 2/17/2021 Lot # N/A  Patient died at a local hospital 11/25/2021 from heart failure, pallitive care initiated. Not a Covid 19 death"
	"1905460-1"	"1905460-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Dose 1 Moderna 2/17/2021 Lot # N/A  Patient died at a local hospital 11/25/2021 from heart failure, pallitive care initiated. Not a Covid 19 death"
	"1906128-1"	"1906128-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient fully vaccinated for Covid-19 and deceased."
	"1906237-1"	"1906237-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Case was hospitalized and died from Covid 6 months after completing Covid vaccine series.  Was admitted 10/26 with onset of URI symptoms 10/18. Was already on chronic 4 L NC O2 prior to illness. Required high flow nasal cannula oxygen immediately upon admission. Was treated with full course of dexamethasone with some initial improvement in oxygenation. Then began to decompensate again and failed attempts at diuresis with worsening renal function. He wanted to go home on hospice, but was requiring too much supplemental O2 to make this feasible, and probably would have been in florid respiratory distress before leaving the hospital. He further decompensated and his family was called into the hospital. He removed his bipap and placed 15 L mask so could talk with his family. Then he removed the mask and quickly drifted to sleep. Time of death 1620."
	"1906237-1"	"1906237-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Case was hospitalized and died from Covid 6 months after completing Covid vaccine series.  Was admitted 10/26 with onset of URI symptoms 10/18. Was already on chronic 4 L NC O2 prior to illness. Required high flow nasal cannula oxygen immediately upon admission. Was treated with full course of dexamethasone with some initial improvement in oxygenation. Then began to decompensate again and failed attempts at diuresis with worsening renal function. He wanted to go home on hospice, but was requiring too much supplemental O2 to make this feasible, and probably would have been in florid respiratory distress before leaving the hospital. He further decompensated and his family was called into the hospital. He removed his bipap and placed 15 L mask so could talk with his family. Then he removed the mask and quickly drifted to sleep. Time of death 1620."
	"1906237-1"	"1906237-1"	"POLYURIA"	"10036142"	"65-79 years"	"65-79"	"Case was hospitalized and died from Covid 6 months after completing Covid vaccine series.  Was admitted 10/26 with onset of URI symptoms 10/18. Was already on chronic 4 L NC O2 prior to illness. Required high flow nasal cannula oxygen immediately upon admission. Was treated with full course of dexamethasone with some initial improvement in oxygenation. Then began to decompensate again and failed attempts at diuresis with worsening renal function. He wanted to go home on hospice, but was requiring too much supplemental O2 to make this feasible, and probably would have been in florid respiratory distress before leaving the hospital. He further decompensated and his family was called into the hospital. He removed his bipap and placed 15 L mask so could talk with his family. Then he removed the mask and quickly drifted to sleep. Time of death 1620."
	"1906237-1"	"1906237-1"	"POSITIVE AIRWAY PRESSURE THERAPY"	"10086397"	"65-79 years"	"65-79"	"Case was hospitalized and died from Covid 6 months after completing Covid vaccine series.  Was admitted 10/26 with onset of URI symptoms 10/18. Was already on chronic 4 L NC O2 prior to illness. Required high flow nasal cannula oxygen immediately upon admission. Was treated with full course of dexamethasone with some initial improvement in oxygenation. Then began to decompensate again and failed attempts at diuresis with worsening renal function. He wanted to go home on hospice, but was requiring too much supplemental O2 to make this feasible, and probably would have been in florid respiratory distress before leaving the hospital. He further decompensated and his family was called into the hospital. He removed his bipap and placed 15 L mask so could talk with his family. Then he removed the mask and quickly drifted to sleep. Time of death 1620."
	"1906237-1"	"1906237-1"	"RENAL IMPAIRMENT"	"10062237"	"65-79 years"	"65-79"	"Case was hospitalized and died from Covid 6 months after completing Covid vaccine series.  Was admitted 10/26 with onset of URI symptoms 10/18. Was already on chronic 4 L NC O2 prior to illness. Required high flow nasal cannula oxygen immediately upon admission. Was treated with full course of dexamethasone with some initial improvement in oxygenation. Then began to decompensate again and failed attempts at diuresis with worsening renal function. He wanted to go home on hospice, but was requiring too much supplemental O2 to make this feasible, and probably would have been in florid respiratory distress before leaving the hospital. He further decompensated and his family was called into the hospital. He removed his bipap and placed 15 L mask so could talk with his family. Then he removed the mask and quickly drifted to sleep. Time of death 1620."
	"1906237-1"	"1906237-1"	"RESPIRATORY SYMPTOM"	"10075535"	"65-79 years"	"65-79"	"Case was hospitalized and died from Covid 6 months after completing Covid vaccine series.  Was admitted 10/26 with onset of URI symptoms 10/18. Was already on chronic 4 L NC O2 prior to illness. Required high flow nasal cannula oxygen immediately upon admission. Was treated with full course of dexamethasone with some initial improvement in oxygenation. Then began to decompensate again and failed attempts at diuresis with worsening renal function. He wanted to go home on hospice, but was requiring too much supplemental O2 to make this feasible, and probably would have been in florid respiratory distress before leaving the hospital. He further decompensated and his family was called into the hospital. He removed his bipap and placed 15 L mask so could talk with his family. Then he removed the mask and quickly drifted to sleep. Time of death 1620."
	"1906237-1"	"1906237-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Case was hospitalized and died from Covid 6 months after completing Covid vaccine series.  Was admitted 10/26 with onset of URI symptoms 10/18. Was already on chronic 4 L NC O2 prior to illness. Required high flow nasal cannula oxygen immediately upon admission. Was treated with full course of dexamethasone with some initial improvement in oxygenation. Then began to decompensate again and failed attempts at diuresis with worsening renal function. He wanted to go home on hospice, but was requiring too much supplemental O2 to make this feasible, and probably would have been in florid respiratory distress before leaving the hospital. He further decompensated and his family was called into the hospital. He removed his bipap and placed 15 L mask so could talk with his family. Then he removed the mask and quickly drifted to sleep. Time of death 1620."
	"1909502-1"	"1909502-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Client fully vaccinated for COVID-19 and tested positive via PCR on 10/21/21. Client died on 11/14/2021 from COVID-19"
	"1909502-1"	"1909502-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Client fully vaccinated for COVID-19 and tested positive via PCR on 10/21/21. Client died on 11/14/2021 from COVID-19"
	"1909502-1"	"1909502-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Client fully vaccinated for COVID-19 and tested positive via PCR on 10/21/21. Client died on 11/14/2021 from COVID-19"
	"1909675-1"	"1909675-1"	"ABDOMINAL DISCOMFORT"	"10000059"	"65-79 years"	"65-79"	"Son states: 11/15/21: Both father and mother received Moderna booster.  They both started having stomach issues and diarrhea some time later. The wife's symptoms resolved in about 3 days.  The husband's symptoms continued.  11/22 or 11/23/21  His father was complaining of intense stomach pain and his abdomen was distended, so his wife took him to the ER.  He was admitted to Medical Center and stayed for 5 days  They performed exploratory surgery on his father and it was decided they would remove his colon because his small intestine was swollen and twisted on itself.  He had the surgery and a colostomy.    11/26/21: The surgery did not resolve his symptoms and his GI system continued to swell until he aspirated on his stomach contents.  11/27/21:  Date of death."
	"1909675-1"	"1909675-1"	"ABDOMINAL DISTENSION"	"10000060"	"65-79 years"	"65-79"	"Son states: 11/15/21: Both father and mother received Moderna booster.  They both started having stomach issues and diarrhea some time later. The wife's symptoms resolved in about 3 days.  The husband's symptoms continued.  11/22 or 11/23/21  His father was complaining of intense stomach pain and his abdomen was distended, so his wife took him to the ER.  He was admitted to Medical Center and stayed for 5 days  They performed exploratory surgery on his father and it was decided they would remove his colon because his small intestine was swollen and twisted on itself.  He had the surgery and a colostomy.    11/26/21: The surgery did not resolve his symptoms and his GI system continued to swell until he aspirated on his stomach contents.  11/27/21:  Date of death."
	"1909675-1"	"1909675-1"	"ABDOMINAL PAIN UPPER"	"10000087"	"65-79 years"	"65-79"	"Son states: 11/15/21: Both father and mother received Moderna booster.  They both started having stomach issues and diarrhea some time later. The wife's symptoms resolved in about 3 days.  The husband's symptoms continued.  11/22 or 11/23/21  His father was complaining of intense stomach pain and his abdomen was distended, so his wife took him to the ER.  He was admitted to Medical Center and stayed for 5 days  They performed exploratory surgery on his father and it was decided they would remove his colon because his small intestine was swollen and twisted on itself.  He had the surgery and a colostomy.    11/26/21: The surgery did not resolve his symptoms and his GI system continued to swell until he aspirated on his stomach contents.  11/27/21:  Date of death."
	"1909675-1"	"1909675-1"	"ASPIRATION"	"10003504"	"65-79 years"	"65-79"	"Son states: 11/15/21: Both father and mother received Moderna booster.  They both started having stomach issues and diarrhea some time later. The wife's symptoms resolved in about 3 days.  The husband's symptoms continued.  11/22 or 11/23/21  His father was complaining of intense stomach pain and his abdomen was distended, so his wife took him to the ER.  He was admitted to Medical Center and stayed for 5 days  They performed exploratory surgery on his father and it was decided they would remove his colon because his small intestine was swollen and twisted on itself.  He had the surgery and a colostomy.    11/26/21: The surgery did not resolve his symptoms and his GI system continued to swell until he aspirated on his stomach contents.  11/27/21:  Date of death."
	"1909675-1"	"1909675-1"	"COLECTOMY"	"10061778"	"65-79 years"	"65-79"	"Son states: 11/15/21: Both father and mother received Moderna booster.  They both started having stomach issues and diarrhea some time later. The wife's symptoms resolved in about 3 days.  The husband's symptoms continued.  11/22 or 11/23/21  His father was complaining of intense stomach pain and his abdomen was distended, so his wife took him to the ER.  He was admitted to Medical Center and stayed for 5 days  They performed exploratory surgery on his father and it was decided they would remove his colon because his small intestine was swollen and twisted on itself.  He had the surgery and a colostomy.    11/26/21: The surgery did not resolve his symptoms and his GI system continued to swell until he aspirated on his stomach contents.  11/27/21:  Date of death."
	"1909675-1"	"1909675-1"	"COLOSTOMY"	"10010041"	"65-79 years"	"65-79"	"Son states: 11/15/21: Both father and mother received Moderna booster.  They both started having stomach issues and diarrhea some time later. The wife's symptoms resolved in about 3 days.  The husband's symptoms continued.  11/22 or 11/23/21  His father was complaining of intense stomach pain and his abdomen was distended, so his wife took him to the ER.  He was admitted to Medical Center and stayed for 5 days  They performed exploratory surgery on his father and it was decided they would remove his colon because his small intestine was swollen and twisted on itself.  He had the surgery and a colostomy.    11/26/21: The surgery did not resolve his symptoms and his GI system continued to swell until he aspirated on his stomach contents.  11/27/21:  Date of death."
	"1909675-1"	"1909675-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Son states: 11/15/21: Both father and mother received Moderna booster.  They both started having stomach issues and diarrhea some time later. The wife's symptoms resolved in about 3 days.  The husband's symptoms continued.  11/22 or 11/23/21  His father was complaining of intense stomach pain and his abdomen was distended, so his wife took him to the ER.  He was admitted to Medical Center and stayed for 5 days  They performed exploratory surgery on his father and it was decided they would remove his colon because his small intestine was swollen and twisted on itself.  He had the surgery and a colostomy.    11/26/21: The surgery did not resolve his symptoms and his GI system continued to swell until he aspirated on his stomach contents.  11/27/21:  Date of death."
	"1909675-1"	"1909675-1"	"DIARRHOEA"	"10012735"	"65-79 years"	"65-79"	"Son states: 11/15/21: Both father and mother received Moderna booster.  They both started having stomach issues and diarrhea some time later. The wife's symptoms resolved in about 3 days.  The husband's symptoms continued.  11/22 or 11/23/21  His father was complaining of intense stomach pain and his abdomen was distended, so his wife took him to the ER.  He was admitted to Medical Center and stayed for 5 days  They performed exploratory surgery on his father and it was decided they would remove his colon because his small intestine was swollen and twisted on itself.  He had the surgery and a colostomy.    11/26/21: The surgery did not resolve his symptoms and his GI system continued to swell until he aspirated on his stomach contents.  11/27/21:  Date of death."
	"1909675-1"	"1909675-1"	"EXPLORATORY OPERATION"	"10056589"	"65-79 years"	"65-79"	"Son states: 11/15/21: Both father and mother received Moderna booster.  They both started having stomach issues and diarrhea some time later. The wife's symptoms resolved in about 3 days.  The husband's symptoms continued.  11/22 or 11/23/21  His father was complaining of intense stomach pain and his abdomen was distended, so his wife took him to the ER.  He was admitted to Medical Center and stayed for 5 days  They performed exploratory surgery on his father and it was decided they would remove his colon because his small intestine was swollen and twisted on itself.  He had the surgery and a colostomy.    11/26/21: The surgery did not resolve his symptoms and his GI system continued to swell until he aspirated on his stomach contents.  11/27/21:  Date of death."
	"1909675-1"	"1909675-1"	"GASTROINTESTINAL INFLAMMATION"	"10064147"	"65-79 years"	"65-79"	"Son states: 11/15/21: Both father and mother received Moderna booster.  They both started having stomach issues and diarrhea some time later. The wife's symptoms resolved in about 3 days.  The husband's symptoms continued.  11/22 or 11/23/21  His father was complaining of intense stomach pain and his abdomen was distended, so his wife took him to the ER.  He was admitted to Medical Center and stayed for 5 days  They performed exploratory surgery on his father and it was decided they would remove his colon because his small intestine was swollen and twisted on itself.  He had the surgery and a colostomy.    11/26/21: The surgery did not resolve his symptoms and his GI system continued to swell until he aspirated on his stomach contents.  11/27/21:  Date of death."
	"1909675-1"	"1909675-1"	"VOLVULUS"	"10047697"	"65-79 years"	"65-79"	"Son states: 11/15/21: Both father and mother received Moderna booster.  They both started having stomach issues and diarrhea some time later. The wife's symptoms resolved in about 3 days.  The husband's symptoms continued.  11/22 or 11/23/21  His father was complaining of intense stomach pain and his abdomen was distended, so his wife took him to the ER.  He was admitted to Medical Center and stayed for 5 days  They performed exploratory surgery on his father and it was decided they would remove his colon because his small intestine was swollen and twisted on itself.  He had the surgery and a colostomy.    11/26/21: The surgery did not resolve his symptoms and his GI system continued to swell until he aspirated on his stomach contents.  11/27/21:  Date of death."
	"1909908-1"	"1909908-1"	"ANGIOGRAM NORMAL"	"10061638"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"ANTICOAGULANT THERAPY"	"10053468"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"BLOOD CREATININE INCREASED"	"10005483"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"ENTERAL NUTRITION"	"10052591"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"OLIGURIA"	"10030302"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"PNEUMOMEDIASTINUM"	"10050184"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"POSITIVE AIRWAY PRESSURE THERAPY"	"10086397"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"RESPIRATORY FAILURE"	"10038695"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"SHOCK"	"10040560"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"SUBCUTANEOUS EMPHYSEMA"	"10042344"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1909908-1"	"1909908-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	""Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died.  Provider discharge note below:  ""67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy.  CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP.  He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21.  No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated.  The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21.  Tube feedings were initiated for nutritional support.  Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine.  Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization.  Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care.  Clinical condition continued to decline. PRN morphine was started for air hunger and comfort.  By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70's to low 90's. Wife was informed that pt actively dying and no escalation of care added to code status.  The pt died on 11/5/21 at 1336 with wife at bedside. """"
	"1912821-1"	"1912821-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Dose 1 given 2/4/2021 Moderna Lot # 016M20A, Patient died in the hospital from Covid 19"
	"1912821-1"	"1912821-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Dose 1 given 2/4/2021 Moderna Lot # 016M20A, Patient died in the hospital from Covid 19"
	"1913376-1"	"1913376-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Hospitalized, diagnosed and expired from COVID while fully vaccinated"
	"1913376-1"	"1913376-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Hospitalized, diagnosed and expired from COVID while fully vaccinated"
	"1913441-1"	"1913441-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Diagnosed and hospitalized with COVID while fully immunized"
	"1913465-1"	"1913465-1"	"ABNORMAL BEHAVIOUR"	"10061422"	"65-79 years"	"65-79"	"immediately became very ill, 9 days later (03/25/21) patient was found nearly dead, rarced to hospital, on the way there he became unresponsive, ambulance carried him the rest of the way 8 days in icu, 4 days on the floor, discharged with acute non- alcoholic liver non-stem heart attack, DOES NOT DRINK, he exibited a typical behavior, therefor they couldnt get his elevated amonia down, never medically responded,was discharged home, 8 days later condition worsened, he was not medically responding as expected, rectal bleeding, discharged on hospice diagnosed with portal vein thrombosis never went back to normal self. died in 8 weeks"
	"1913465-1"	"1913465-1"	"ACUTE MYOCARDIAL INFARCTION"	"10000891"	"65-79 years"	"65-79"	"immediately became very ill, 9 days later (03/25/21) patient was found nearly dead, rarced to hospital, on the way there he became unresponsive, ambulance carried him the rest of the way 8 days in icu, 4 days on the floor, discharged with acute non- alcoholic liver non-stem heart attack, DOES NOT DRINK, he exibited a typical behavior, therefor they couldnt get his elevated amonia down, never medically responded,was discharged home, 8 days later condition worsened, he was not medically responding as expected, rectal bleeding, discharged on hospice diagnosed with portal vein thrombosis never went back to normal self. died in 8 weeks"
	"1913465-1"	"1913465-1"	"AMMONIA INCREASED"	"10001946"	"65-79 years"	"65-79"	"immediately became very ill, 9 days later (03/25/21) patient was found nearly dead, rarced to hospital, on the way there he became unresponsive, ambulance carried him the rest of the way 8 days in icu, 4 days on the floor, discharged with acute non- alcoholic liver non-stem heart attack, DOES NOT DRINK, he exibited a typical behavior, therefor they couldnt get his elevated amonia down, never medically responded,was discharged home, 8 days later condition worsened, he was not medically responding as expected, rectal bleeding, discharged on hospice diagnosed with portal vein thrombosis never went back to normal self. died in 8 weeks"
	"1913465-1"	"1913465-1"	"COMPUTERISED TOMOGRAM ABNORMAL"	"10010235"	"65-79 years"	"65-79"	"immediately became very ill, 9 days later (03/25/21) patient was found nearly dead, rarced to hospital, on the way there he became unresponsive, ambulance carried him the rest of the way 8 days in icu, 4 days on the floor, discharged with acute non- alcoholic liver non-stem heart attack, DOES NOT DRINK, he exibited a typical behavior, therefor they couldnt get his elevated amonia down, never medically responded,was discharged home, 8 days later condition worsened, he was not medically responding as expected, rectal bleeding, discharged on hospice diagnosed with portal vein thrombosis never went back to normal self. died in 8 weeks"
	"1913465-1"	"1913465-1"	"COMPUTERISED TOMOGRAM SPINE"	"10081777"	"65-79 years"	"65-79"	"immediately became very ill, 9 days later (03/25/21) patient was found nearly dead, rarced to hospital, on the way there he became unresponsive, ambulance carried him the rest of the way 8 days in icu, 4 days on the floor, discharged with acute non- alcoholic liver non-stem heart attack, DOES NOT DRINK, he exibited a typical behavior, therefor they couldnt get his elevated amonia down, never medically responded,was discharged home, 8 days later condition worsened, he was not medically responding as expected, rectal bleeding, discharged on hospice diagnosed with portal vein thrombosis never went back to normal self. died in 8 weeks"
	"1913465-1"	"1913465-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"immediately became very ill, 9 days later (03/25/21) patient was found nearly dead, rarced to hospital, on the way there he became unresponsive, ambulance carried him the rest of the way 8 days in icu, 4 days on the floor, discharged with acute non- alcoholic liver non-stem heart attack, DOES NOT DRINK, he exibited a typical behavior, therefor they couldnt get his elevated amonia down, never medically responded,was discharged home, 8 days later condition worsened, he was not medically responding as expected, rectal bleeding, discharged on hospice diagnosed with portal vein thrombosis never went back to normal self. died in 8 weeks"
	"1913465-1"	"1913465-1"	"ELECTROCARDIOGRAM"	"10014362"	"65-79 years"	"65-79"	"immediately became very ill, 9 days later (03/25/21) patient was found nearly dead, rarced to hospital, on the way there he became unresponsive, ambulance carried him the rest of the way 8 days in icu, 4 days on the floor, discharged with acute non- alcoholic liver non-stem heart attack, DOES NOT DRINK, he exibited a typical behavior, therefor they couldnt get his elevated amonia down, never medically responded,was discharged home, 8 days later condition worsened, he was not medically responding as expected, rectal bleeding, discharged on hospice diagnosed with portal vein thrombosis never went back to normal self. died in 8 weeks"
	"1913465-1"	"1913465-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"immediately became very ill, 9 days later (03/25/21) patient was found nearly dead, rarced to hospital, on the way there he became unresponsive, ambulance carried him the rest of the way 8 days in icu, 4 days on the floor, discharged with acute non- alcoholic liver non-stem heart attack, DOES NOT DRINK, he exibited a typical behavior, therefor they couldnt get his elevated amonia down, never medically responded,was discharged home, 8 days later condition worsened, he was not medically responding as expected, rectal bleeding, discharged on hospice diagnosed with portal vein thrombosis never went back to normal self. died in 8 weeks"
	"1913465-1"	"1913465-1"	"MAGNETIC RESONANCE IMAGING"	"10078223"	"65-79 years"	"65-79"	"immediately became very ill, 9 days later (03/25/21) patient was found nearly dead, rarced to hospital, on the way there he became unresponsive, ambulance carried him the rest of the way 8 days in icu, 4 days on the floor, discharged with acute non- alcoholic liver non-stem heart attack, DOES NOT DRINK, he exibited a typical behavior, therefor they couldnt get his elevated amonia down, never medically responded,was discharged home, 8 days later condition worsened, he was not medically responding as expected, rectal bleeding, discharged on hospice diagnosed with portal vein thrombosis never went back to normal self. died in 8 weeks"
	"1913465-1"	"1913465-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"immediately became very ill, 9 days later (03/25/21) patient was found nearly dead, rarced to hospital, on the way there he became unresponsive, ambulance carried him the rest of the way 8 days in icu, 4 days on the floor, discharged with acute non- alcoholic liver non-stem heart attack, DOES NOT DRINK, he exibited a typical behavior, therefor they couldnt get his elevated amonia down, never medically responded,was discharged home, 8 days later condition worsened, he was not medically responding as expected, rectal bleeding, discharged on hospice diagnosed with portal vein thrombosis never went back to normal self. died in 8 weeks"
	"1913465-1"	"1913465-1"	"NEAR DEATH EXPERIENCE"	"10068111"	"65-79 years"	"65-79"	"immediately became very ill, 9 days later (03/25/21) patient was found nearly dead, rarced to hospital, on the way there he became unresponsive, ambulance carried him the rest of the way 8 days in icu, 4 days on the floor, discharged with acute non- alcoholic liver non-stem heart attack, DOES NOT DRINK, he exibited a typical behavior, therefor they couldnt get his elevated amonia down, never medically responded,was discharged home, 8 days later condition worsened, he was not medically responding as expected, rectal bleeding, discharged on hospice diagnosed with portal vein thrombosis never went back to normal self. died in 8 weeks"
	"1913465-1"	"1913465-1"	"NONALCOHOLIC FATTY LIVER DISEASE"	"10082249"	"65-79 years"	"65-79"	"immediately became very ill, 9 days later (03/25/21) patient was found nearly dead, rarced to hospital, on the way there he became unresponsive, ambulance carried him the rest of the way 8 days in icu, 4 days on the floor, discharged with acute non- alcoholic liver non-stem heart attack, DOES NOT DRINK, he exibited a typical behavior, therefor they couldnt get his elevated amonia down, never medically responded,was discharged home, 8 days later condition worsened, he was not medically responding as expected, rectal bleeding, discharged on hospice diagnosed with portal vein thrombosis never went back to normal self. died in 8 weeks"
	"1913465-1"	"1913465-1"	"PORTAL VEIN THROMBOSIS"	"10036206"	"65-79 years"	"65-79"	"immediately became very ill, 9 days later (03/25/21) patient was found nearly dead, rarced to hospital, on the way there he became unresponsive, ambulance carried him the rest of the way 8 days in icu, 4 days on the floor, discharged with acute non- alcoholic liver non-stem heart attack, DOES NOT DRINK, he exibited a typical behavior, therefor they couldnt get his elevated amonia down, never medically responded,was discharged home, 8 days later condition worsened, he was not medically responding as expected, rectal bleeding, discharged on hospice diagnosed with portal vein thrombosis never went back to normal self. died in 8 weeks"
	"1913465-1"	"1913465-1"	"RECTAL HAEMORRHAGE"	"10038063"	"65-79 years"	"65-79"	"immediately became very ill, 9 days later (03/25/21) patient was found nearly dead, rarced to hospital, on the way there he became unresponsive, ambulance carried him the rest of the way 8 days in icu, 4 days on the floor, discharged with acute non- alcoholic liver non-stem heart attack, DOES NOT DRINK, he exibited a typical behavior, therefor they couldnt get his elevated amonia down, never medically responded,was discharged home, 8 days later condition worsened, he was not medically responding as expected, rectal bleeding, discharged on hospice diagnosed with portal vein thrombosis never went back to normal self. died in 8 weeks"
	"1913465-1"	"1913465-1"	"ULTRASOUND KIDNEY"	"10045421"	"65-79 years"	"65-79"	"immediately became very ill, 9 days later (03/25/21) patient was found nearly dead, rarced to hospital, on the way there he became unresponsive, ambulance carried him the rest of the way 8 days in icu, 4 days on the floor, discharged with acute non- alcoholic liver non-stem heart attack, DOES NOT DRINK, he exibited a typical behavior, therefor they couldnt get his elevated amonia down, never medically responded,was discharged home, 8 days later condition worsened, he was not medically responding as expected, rectal bleeding, discharged on hospice diagnosed with portal vein thrombosis never went back to normal self. died in 8 weeks"
	"1913465-1"	"1913465-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"immediately became very ill, 9 days later (03/25/21) patient was found nearly dead, rarced to hospital, on the way there he became unresponsive, ambulance carried him the rest of the way 8 days in icu, 4 days on the floor, discharged with acute non- alcoholic liver non-stem heart attack, DOES NOT DRINK, he exibited a typical behavior, therefor they couldnt get his elevated amonia down, never medically responded,was discharged home, 8 days later condition worsened, he was not medically responding as expected, rectal bleeding, discharged on hospice diagnosed with portal vein thrombosis never went back to normal self. died in 8 weeks"
	"1917185-1"	"1917185-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"ANTICOAGULANT THERAPY"	"10053468"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"BLOOD BILIRUBIN INCREASED"	"10005364"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"BLOOD CREATININE INCREASED"	"10005483"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"BLOOD PRESSURE ABNORMAL"	"10005728"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"BRONCHOSCOPY"	"10006479"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"CARDIAC TELEMETRY ABNORMAL"	"10053450"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"CATHETER PLACEMENT"	"10052915"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"COMPUTERISED TOMOGRAM ABDOMEN ABNORMAL"	"10057798"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"COMPUTERISED TOMOGRAM THORAX ABNORMAL"	"10057799"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"DEEP VEIN THROMBOSIS"	"10051055"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"ELECTROCARDIOGRAM ST SEGMENT ELEVATION"	"10014392"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"ENTERAL NUTRITION"	"10052591"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"FIBRIN D DIMER INCREASED"	"10016581"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"HAEMODIALYSIS"	"10018875"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"HEPATOBILIARY SCAN NORMAL"	"10077444"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"HYPERGLYCAEMIA"	"10020635"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"ISCHAEMIA"	"10061255"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"KLEBSIELLA TEST POSITIVE"	"10070091"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"LABORATORY TEST ABNORMAL"	"10023547"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"LEUKOCYTOSIS"	"10024378"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"LIPASE NORMAL"	"10024575"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"METABOLIC ACIDOSIS"	"10027417"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"PERIPANCREATIC FLUID COLLECTION"	"10050466"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"PLATELET COUNT DECREASED"	"10035528"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"PNEUMONITIS ASPIRATION"	"10035744"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"SERRATIA TEST POSITIVE"	"10070128"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"SHOCK"	"10040560"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"TACHYPNOEA"	"10043089"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"TRANSAMINASES INCREASED"	"10054889"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"TROPONIN INCREASED"	"10058267"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"ULTRASOUND ABDOMEN ABNORMAL"	"10052039"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
	"1917185-1"	"1917185-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"Death Note: Date of Admission  11/08/2021   Date of Discharge  11/30/2021   Reason for Hospitalization   Severe COVID-19 PNA  Hospital Course   Patient was a 68 yoM with OSA, ICCM w/ HFrEF 35%, VT s/p AICD on amiodarone, DM2 (newly diagnosed), HTN, and HLD who was initially admitted to the MICU on 11/8 for acute hypoxemic respiratory failure 2/2 COVID infection. In  ED, CT C/A/P was performed with his CT Chest showing signs of multifocal PNA c/w Covid. Initial labs were significant for leukocytosis, elevated D. dimer, AKI (Cr 2.89), HAGMA,  transaminitis, and elevated bilirubin; admitted to MICU for management. Patient was initially on NIPPV but subsequently intubated on 11/8. S/P on Remdesivir/dexamethasone/tocilizumab x1.  Hospital course c/w ongoing hypoxemia requiring bronchoscopy (11/14), RPP growing Serratia and klebsiella, s/p ertapenem. Persistent hypotension requiring initiation of stress dose steroids w/ hyperglycemia requiring initiation of insulin drip. On 11/14, the patient went into shock requiring multiple pressors. Due to shock he had ARF and nephrology was consulted; initiated HD on 11/15-11/18. ST elevation on telemetry 11/16 concerning for inferior MI, likely demand ischemia. Max troponin 55 (on admission 35). Vancomycin and meropenem added 11/16 due to shock and leukocytosis with positive QTL on 11/15 for serratia, but deescalated back to ertapenem. CT abdomen 11/20  with concern for pancreatitis noted findings of acute pancreatitis with small amount of ill-defined peripancreatic fluid, lipase was normal.  Palliative care consulted and were following.  Goals of care conversation had on 11/22 with patient's brothers and daughter.  Decision was made to have daughter as the primary decision-maker.  Decision from goals of care conversation was to make patient full code and proceed forward with disease oriented treatment.  Plan from family would be to continue ventilator treatment with plan for tracheostomy and PEG tube when appropriate.   Septic picture with RUQ US concern for obstructive stone vs infected stone, GI consulted for possible ERCP but not planning intervention at this time. ACS was consulted for concern of cholecystitis, they reviewed and recommended HIDA scan. HIDA scan was completed with no obstruction of the cystic or common bile duct, there was no evidence of cholecystitis, likely passed stone that was noted on ultrasound.  Concern with decreasing platelets that patient could have HIT, d/c heparin and placed on argatroban drip for DVT of RIJ. Heparin PF4 lab and unfractionated heparin were negative. Patient did develop some tachypnea on ventilator 11/26, fentanyl drip was restarted.  On 11/27 decreased tube feeds to 30 cc/h due to emesis overnight with feeds and free water flushes. Held tube feeds again on 11/28 after emesis.   11/27: Consulted ACS for trach and PEG (consider J-tube based on recent emesis) placement however patient on pressors and still requiring too high level of oxygen.  Placed right femoral triple-lumen cath.  11/28: trial of dobutamine drip cause more hypotension so this was held, started on vasopressin overnight due to worsening hypotension  11/29: significantly worsening respiratory status with O2 sats in mid to low 80s on 100% FiO2 on vent; P/F ratio 51; increasing sedation with versed and trial iNO; poor response to PEEP increase; concern patient remains intravascularly depleted; concern for aspiration pneumonitis   Daughter, was updated about declining prognosis at bedside on 11/29 during rounds. Questions were answered. Patient significantly worsened on 11/29, was requiring three IV pressors and unable to maintain adequate BP. His oxygenation drop to around 80% with 100% FiO2 on the vent and had minimal imporvement with more sedation and iNO. Family notified again in the evening on 11/29, patient made DNAR. Family elected to continue treatment for ~24 more hours and then would consider comfort care. Patient passed on 11/30/21 at 0937.  Discharge Diagnoses      COVID-19  Severe Acute Hypoxic Respiratory Failure on mechanical ventilation  Severe hypotension and shock, requiring three IV pressures  Aspiration pneumonitis"
"---"
"Dataset: The Vaccine Adverse Event Reporting System (VAERS)"
"Query Parameters:"
"Title: 211214 CDC covid VAERS report - all reports.txt"
"Age: 65-79 years"
"Date Died: 2020; 2021"
"Date of Onset: 2020; 2021"
"Date Report Completed: 2020; 2021"
"Date Report Received: 2020; 2021"
"Date Vaccinated: 2020; 2021"
"State / Territory: Michigan; Minnesota; Mississippi; Missouri; Montana; Nebraska; Nevada; New Hampshire"
"Vaccine Products: COVID19 VACCINE (COVID19)"
"VAERS ID: All"
"Group By: VAERS ID; Symptoms; Age"
"Show Totals: False"
"Show Zero Values: Disabled"
"---"
"Help: See http://wonder.cdc.gov/wonder/help/vaers.html for more information."
"---"
"Query Date: Dec 14, 2021 4:24:10 PM"
"---"
"Suggested Citation: Accessed at http://wonder.cdc.gov/vaers.html on Dec 14, 2021 4:24:10 PM"
"---"
Messages:
"1. The full results are too long to be displayed, only non-zero rows are available."
"2. VAERS data in CDC WONDER are updated every Friday. Hence, results for the same query can change from week to week."
"3. These results are for 377 total events."
"4. When grouped by VAERS ID, results initially don't show Events Reported, Percent, or totals. Use Quick or More Options to"
"restore them, if you wish."
"5. Click on a VAERS ID to see a report containing detailed information for the event."
"---"
Footnotes:
"1. Submitting a report to VAERS does not mean that healthcare personnel or the vaccine caused or contributed to the adverse"
"event (possible side effect)."
"---"
Caveats:
"1. <p> VAERS accepts reports of adverse events and reactions that occur following vaccination. Healthcare providers, vaccine"
"manufacturers, and the public can submit reports to VAERS. While very important in monitoring vaccine safety, VAERS reports"
"alone cannot be used to determine if a vaccine caused or contributed to an adverse event or illness. The reports may contain"
"information that is incomplete, inaccurate, coincidental, or unverifiable. Most reports to VAERS are voluntary, which means they"
"are subject to biases. This creates specific limitations on how the data can be used scientifically. Data from VAERS reports"
"should always be interpreted with these limitations in mind. </p> <p> The strengths of VAERS are that it is national in scope"
"and can quickly provide an early warning of a safety problem with a vaccine. As part of CDC and FDA's multi-system approach to"
"post-licensure vaccine safety monitoring, VAERS is designed to rapidly detect unusual or unexpected patterns of adverse events,"
"also known as ""safety signals."" If a safety signal is found in VAERS, further studies can be done in safety systems such as"
"the CDC's Vaccine Safety Datalink (VSD) or the Clinical Immunization Safety Assessment (CISA) project. These systems do not have"
"the same limitations as VAERS, and can better assess health risks and possible connections between adverse events and a vaccine."
"</p> <p> Key considerations and limitations of VAERS data: <ul><li> Vaccine providers are encouraged to report any clinically"
"significant health problem following vaccination to VAERS, whether or not they believe the vaccine was the cause. </li><li>"
"Reports may include incomplete, inaccurate, coincidental and unverified information. </li><li> The number of reports alone"
"cannot be interpreted or used to reach conclusions about the existence, severity, frequency, or rates of problems associated"
"with vaccines. </li><li> VAERS data are limited to vaccine adverse event reports received between 1990 and the most recent date"
"for which data are available. </li><li> VAERS data do not represent all known safety information for a vaccine and should be"
"interpreted in the context of other scientific information. </li></ul> </p>"
"2."
"3. Some items may have more than 1 occurrence in any single event report, such as Symptoms, Vaccine Products, Manufacturers, and"
"Event Categories. If data are grouped by any of these items, then the number in the Events Reported column may exceed the total"
"number of unique events. If percentages are shown, then the associated percentage of total unique event reports will exceed 100%"
"in such cases. For example, the number of Symptoms mentioned is likely to exceed the number of events reported, because many"
"reports include more than 1 Symptom. When more than 1 Symptom occurs in a single report, then the percentage of Symptoms to"
"unique events is more than 100%. More information: http://wonder.cdc.gov/wonder/help/vaers.html#Suppress."
"4. Data contains VAERS reports processed as of 12/03/2021. The VAERS data in WONDER are updated weekly, yet the VAERS system"
"receives continuous updates including revisions and new reports for preceding time periods. Duplicate event reports and/or"
"reports determined to be false are removed from VAERS. More information: http://wonder.cdc.gov/wonder/help/vaers.html#Reporting."
"5. About COVID19 vaccines: <UL><LI> For more information on how many persons have been vaccinated in the US for COVID19 to date,"
"see https://covid.cdc.gov/covid-data-tracker/#vaccinations/: <a target= .. </LI><LI> One report may state that the patient"
"received more than one brand of COVID-19 vaccine on the same visit. This is a reporting error, but explains why the total number"
"of reports may not equal the total number of COVID-19 vaccine doses. </LI></UL>"