"Notes"	"VAERS ID"	"VAERS ID Code"	"Symptoms"	"Symptoms Code"	"Age"	"Age Code"	Adverse Event Description
	"0940866-1"	"0940866-1"	"ABNORMAL BEHAVIOUR"	"10061422"	"65-79 years"	"65-79"	""Patient was found ""acting abnormal"" on 1/9/2021 at 1215. VS HR 20-30's. EMS activated. EMS arrived and patient was found pulseless in PEA/ asystole,  CPR and ACLS initiated and then transported to the MC. Unsuccessful resuscitation  and expired on 1/09/2021 at 1348. Clinical impression Cardiopulmonary arrest.""
	"0940866-1"	"0940866-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	""Patient was found ""acting abnormal"" on 1/9/2021 at 1215. VS HR 20-30's. EMS activated. EMS arrived and patient was found pulseless in PEA/ asystole,  CPR and ACLS initiated and then transported to the MC. Unsuccessful resuscitation  and expired on 1/09/2021 at 1348. Clinical impression Cardiopulmonary arrest.""
	"0940866-1"	"0940866-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"65-79 years"	"65-79"	""Patient was found ""acting abnormal"" on 1/9/2021 at 1215. VS HR 20-30's. EMS activated. EMS arrived and patient was found pulseless in PEA/ asystole,  CPR and ACLS initiated and then transported to the MC. Unsuccessful resuscitation  and expired on 1/09/2021 at 1348. Clinical impression Cardiopulmonary arrest.""
	"0940866-1"	"0940866-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	""Patient was found ""acting abnormal"" on 1/9/2021 at 1215. VS HR 20-30's. EMS activated. EMS arrived and patient was found pulseless in PEA/ asystole,  CPR and ACLS initiated and then transported to the MC. Unsuccessful resuscitation  and expired on 1/09/2021 at 1348. Clinical impression Cardiopulmonary arrest.""
	"0940866-1"	"0940866-1"	"PULSE ABSENT"	"10037469"	"65-79 years"	"65-79"	""Patient was found ""acting abnormal"" on 1/9/2021 at 1215. VS HR 20-30's. EMS activated. EMS arrived and patient was found pulseless in PEA/ asystole,  CPR and ACLS initiated and then transported to the MC. Unsuccessful resuscitation  and expired on 1/09/2021 at 1348. Clinical impression Cardiopulmonary arrest.""
	"0940866-1"	"0940866-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	""Patient was found ""acting abnormal"" on 1/9/2021 at 1215. VS HR 20-30's. EMS activated. EMS arrived and patient was found pulseless in PEA/ asystole,  CPR and ACLS initiated and then transported to the MC. Unsuccessful resuscitation  and expired on 1/09/2021 at 1348. Clinical impression Cardiopulmonary arrest.""
	"0946225-1"	"0946225-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"At approximately 10:30pm on 1/14/2021, resident was noted to have a rash on her face, hands, arms, and chest. VS:100.2, 113, 20,108/59, 84% room air. applied nasal cannula at 4-L, telephoned Physician orders 6mg Decadron one time order, a second set of Vitals , reads 99.3, 110, 20, 106/60, 90% on 4-L N/C. On coming shift advised. At approximately 2:00am on 1/15/2021, resident congested and coughing. BP 151/70, pulse 124, temp 98.1 forehead, resp 20 and pulse oc 79% on 3L. At approximately 2:30am PRN cough syrup and breathing tx. Resident's condition began to worsen with breathing tx. This LPN updated at 0248 doctor on resident's condition. Doctor gave permission for resident to go to hospital. At 4:19am the Er called to say resident passed away."
	"0946225-1"	"0946225-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"At approximately 10:30pm on 1/14/2021, resident was noted to have a rash on her face, hands, arms, and chest. VS:100.2, 113, 20,108/59, 84% room air. applied nasal cannula at 4-L, telephoned Physician orders 6mg Decadron one time order, a second set of Vitals , reads 99.3, 110, 20, 106/60, 90% on 4-L N/C. On coming shift advised. At approximately 2:00am on 1/15/2021, resident congested and coughing. BP 151/70, pulse 124, temp 98.1 forehead, resp 20 and pulse oc 79% on 3L. At approximately 2:30am PRN cough syrup and breathing tx. Resident's condition began to worsen with breathing tx. This LPN updated at 0248 doctor on resident's condition. Doctor gave permission for resident to go to hospital. At 4:19am the Er called to say resident passed away."
	"0946225-1"	"0946225-1"	"RASH"	"10037844"	"65-79 years"	"65-79"	"At approximately 10:30pm on 1/14/2021, resident was noted to have a rash on her face, hands, arms, and chest. VS:100.2, 113, 20,108/59, 84% room air. applied nasal cannula at 4-L, telephoned Physician orders 6mg Decadron one time order, a second set of Vitals , reads 99.3, 110, 20, 106/60, 90% on 4-L N/C. On coming shift advised. At approximately 2:00am on 1/15/2021, resident congested and coughing. BP 151/70, pulse 124, temp 98.1 forehead, resp 20 and pulse oc 79% on 3L. At approximately 2:30am PRN cough syrup and breathing tx. Resident's condition began to worsen with breathing tx. This LPN updated at 0248 doctor on resident's condition. Doctor gave permission for resident to go to hospital. At 4:19am the Er called to say resident passed away."
	"0946225-1"	"0946225-1"	"RESPIRATORY TRACT CONGESTION"	"10052251"	"65-79 years"	"65-79"	"At approximately 10:30pm on 1/14/2021, resident was noted to have a rash on her face, hands, arms, and chest. VS:100.2, 113, 20,108/59, 84% room air. applied nasal cannula at 4-L, telephoned Physician orders 6mg Decadron one time order, a second set of Vitals , reads 99.3, 110, 20, 106/60, 90% on 4-L N/C. On coming shift advised. At approximately 2:00am on 1/15/2021, resident congested and coughing. BP 151/70, pulse 124, temp 98.1 forehead, resp 20 and pulse oc 79% on 3L. At approximately 2:30am PRN cough syrup and breathing tx. Resident's condition began to worsen with breathing tx. This LPN updated at 0248 doctor on resident's condition. Doctor gave permission for resident to go to hospital. At 4:19am the Er called to say resident passed away."
	"0947642-1"	"0947642-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"died two days after receiving the vaccine; Fever; This is a spontaneous report from a contactable consumer (patient's stepchild). A 66-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), via an unspecified route of administration, on 07Jan2021 (at the age of 66-years-old) as a single dose for COVID-19 immunization. The patient's medical history was not reported. Concomitant medications included an unspecified statin. The patient experienced fever on 08Jan2021. The patient died two days after receiving the vaccine on 09Jan2021, which was reported as fatal. The clinical course was reported as follows: The patient had a fever the day after getting the vaccine and then he just died in the middle of night. It was reported that it was not clear what exactly happened, but they are looking into this. The clinical outcome of fever was unknown and of died two days after receiving the vaccine was fatal. The patient died on 09Jan2021. The cause of death was not reported.  An autopsy was not performed (was reported to be taking place soon).  The batch/lot number for the vaccine, BNT162B2, was not provided and has been requested during follow up.; Reported Cause(s) of Death: died two days after receiving the vaccine"
	"0947642-1"	"0947642-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"died two days after receiving the vaccine; Fever; This is a spontaneous report from a contactable consumer (patient's stepchild). A 66-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), via an unspecified route of administration, on 07Jan2021 (at the age of 66-years-old) as a single dose for COVID-19 immunization. The patient's medical history was not reported. Concomitant medications included an unspecified statin. The patient experienced fever on 08Jan2021. The patient died two days after receiving the vaccine on 09Jan2021, which was reported as fatal. The clinical course was reported as follows: The patient had a fever the day after getting the vaccine and then he just died in the middle of night. It was reported that it was not clear what exactly happened, but they are looking into this. The clinical outcome of fever was unknown and of died two days after receiving the vaccine was fatal. The patient died on 09Jan2021. The cause of death was not reported.  An autopsy was not performed (was reported to be taking place soon).  The batch/lot number for the vaccine, BNT162B2, was not provided and has been requested during follow up.; Reported Cause(s) of Death: died two days after receiving the vaccine"
	"0952799-1"	"0952799-1"	"APNOEIC ATTACK"	"10002977"	"65-79 years"	"65-79"	"On 1/17/2021 at 4:35 am resident found apneic and pulseless, at 4:40am death confirmed"
	"0952799-1"	"0952799-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"On 1/17/2021 at 4:35 am resident found apneic and pulseless, at 4:40am death confirmed"
	"0952799-1"	"0952799-1"	"PULSE ABSENT"	"10037469"	"65-79 years"	"65-79"	"On 1/17/2021 at 4:35 am resident found apneic and pulseless, at 4:40am death confirmed"
	"0953858-1"	"0953858-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"patient started to decline 1/10/2021, patient seen at facility by medical professional - patient deceased 1/13/2021"
	"0953858-1"	"0953858-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"patient started to decline 1/10/2021, patient seen at facility by medical professional - patient deceased 1/13/2021"
	"0963016-1"	"0963016-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"unknown.  Event occurred after leaving vaccination site"
	"0974443-1"	"0974443-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received Moderna COVID vaccine on 12/30/2020 at a Pharmacy clinic where he was a resident. Nurses at the facility reported that he was responsive and showed no signs of any adverse effects until 1/2/2021 when he was observed slightly unresponsive and staring at the ceiling and trembling. He had a fever of 101F at this time. The facility ordered labs and a rapid COVID test (all of which came back normal) and started IV antibiotics. A few hours later, patient began bleeding from his eyes, nose, and mouth and was sent to the local ER. The patient refused being admitted to the ICU for possible sepsis/hemorrhage and died the following day on 1/3/2021. All healthcare professionals involved agreed that this was not likely due to the vaccine, but needed to be reported nonetheless."
	"0974443-1"	"0974443-1"	"EPISTAXIS"	"10015090"	"65-79 years"	"65-79"	"Patient received Moderna COVID vaccine on 12/30/2020 at a Pharmacy clinic where he was a resident. Nurses at the facility reported that he was responsive and showed no signs of any adverse effects until 1/2/2021 when he was observed slightly unresponsive and staring at the ceiling and trembling. He had a fever of 101F at this time. The facility ordered labs and a rapid COVID test (all of which came back normal) and started IV antibiotics. A few hours later, patient began bleeding from his eyes, nose, and mouth and was sent to the local ER. The patient refused being admitted to the ICU for possible sepsis/hemorrhage and died the following day on 1/3/2021. All healthcare professionals involved agreed that this was not likely due to the vaccine, but needed to be reported nonetheless."
	"0974443-1"	"0974443-1"	"EYE HAEMORRHAGE"	"10015926"	"65-79 years"	"65-79"	"Patient received Moderna COVID vaccine on 12/30/2020 at a Pharmacy clinic where he was a resident. Nurses at the facility reported that he was responsive and showed no signs of any adverse effects until 1/2/2021 when he was observed slightly unresponsive and staring at the ceiling and trembling. He had a fever of 101F at this time. The facility ordered labs and a rapid COVID test (all of which came back normal) and started IV antibiotics. A few hours later, patient began bleeding from his eyes, nose, and mouth and was sent to the local ER. The patient refused being admitted to the ICU for possible sepsis/hemorrhage and died the following day on 1/3/2021. All healthcare professionals involved agreed that this was not likely due to the vaccine, but needed to be reported nonetheless."
	"0974443-1"	"0974443-1"	"FULL BLOOD COUNT NORMAL"	"10017414"	"65-79 years"	"65-79"	"Patient received Moderna COVID vaccine on 12/30/2020 at a Pharmacy clinic where he was a resident. Nurses at the facility reported that he was responsive and showed no signs of any adverse effects until 1/2/2021 when he was observed slightly unresponsive and staring at the ceiling and trembling. He had a fever of 101F at this time. The facility ordered labs and a rapid COVID test (all of which came back normal) and started IV antibiotics. A few hours later, patient began bleeding from his eyes, nose, and mouth and was sent to the local ER. The patient refused being admitted to the ICU for possible sepsis/hemorrhage and died the following day on 1/3/2021. All healthcare professionals involved agreed that this was not likely due to the vaccine, but needed to be reported nonetheless."
	"0974443-1"	"0974443-1"	"METABOLIC FUNCTION TEST NORMAL"	"10062192"	"65-79 years"	"65-79"	"Patient received Moderna COVID vaccine on 12/30/2020 at a Pharmacy clinic where he was a resident. Nurses at the facility reported that he was responsive and showed no signs of any adverse effects until 1/2/2021 when he was observed slightly unresponsive and staring at the ceiling and trembling. He had a fever of 101F at this time. The facility ordered labs and a rapid COVID test (all of which came back normal) and started IV antibiotics. A few hours later, patient began bleeding from his eyes, nose, and mouth and was sent to the local ER. The patient refused being admitted to the ICU for possible sepsis/hemorrhage and died the following day on 1/3/2021. All healthcare professionals involved agreed that this was not likely due to the vaccine, but needed to be reported nonetheless."
	"0974443-1"	"0974443-1"	"MOUTH HAEMORRHAGE"	"10028024"	"65-79 years"	"65-79"	"Patient received Moderna COVID vaccine on 12/30/2020 at a Pharmacy clinic where he was a resident. Nurses at the facility reported that he was responsive and showed no signs of any adverse effects until 1/2/2021 when he was observed slightly unresponsive and staring at the ceiling and trembling. He had a fever of 101F at this time. The facility ordered labs and a rapid COVID test (all of which came back normal) and started IV antibiotics. A few hours later, patient began bleeding from his eyes, nose, and mouth and was sent to the local ER. The patient refused being admitted to the ICU for possible sepsis/hemorrhage and died the following day on 1/3/2021. All healthcare professionals involved agreed that this was not likely due to the vaccine, but needed to be reported nonetheless."
	"0974443-1"	"0974443-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"Patient received Moderna COVID vaccine on 12/30/2020 at a Pharmacy clinic where he was a resident. Nurses at the facility reported that he was responsive and showed no signs of any adverse effects until 1/2/2021 when he was observed slightly unresponsive and staring at the ceiling and trembling. He had a fever of 101F at this time. The facility ordered labs and a rapid COVID test (all of which came back normal) and started IV antibiotics. A few hours later, patient began bleeding from his eyes, nose, and mouth and was sent to the local ER. The patient refused being admitted to the ICU for possible sepsis/hemorrhage and died the following day on 1/3/2021. All healthcare professionals involved agreed that this was not likely due to the vaccine, but needed to be reported nonetheless."
	"0974443-1"	"0974443-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	"Patient received Moderna COVID vaccine on 12/30/2020 at a Pharmacy clinic where he was a resident. Nurses at the facility reported that he was responsive and showed no signs of any adverse effects until 1/2/2021 when he was observed slightly unresponsive and staring at the ceiling and trembling. He had a fever of 101F at this time. The facility ordered labs and a rapid COVID test (all of which came back normal) and started IV antibiotics. A few hours later, patient began bleeding from his eyes, nose, and mouth and was sent to the local ER. The patient refused being admitted to the ICU for possible sepsis/hemorrhage and died the following day on 1/3/2021. All healthcare professionals involved agreed that this was not likely due to the vaccine, but needed to be reported nonetheless."
	"0974443-1"	"0974443-1"	"STARING"	"10041953"	"65-79 years"	"65-79"	"Patient received Moderna COVID vaccine on 12/30/2020 at a Pharmacy clinic where he was a resident. Nurses at the facility reported that he was responsive and showed no signs of any adverse effects until 1/2/2021 when he was observed slightly unresponsive and staring at the ceiling and trembling. He had a fever of 101F at this time. The facility ordered labs and a rapid COVID test (all of which came back normal) and started IV antibiotics. A few hours later, patient began bleeding from his eyes, nose, and mouth and was sent to the local ER. The patient refused being admitted to the ICU for possible sepsis/hemorrhage and died the following day on 1/3/2021. All healthcare professionals involved agreed that this was not likely due to the vaccine, but needed to be reported nonetheless."
	"0974443-1"	"0974443-1"	"TREMOR"	"10044565"	"65-79 years"	"65-79"	"Patient received Moderna COVID vaccine on 12/30/2020 at a Pharmacy clinic where he was a resident. Nurses at the facility reported that he was responsive and showed no signs of any adverse effects until 1/2/2021 when he was observed slightly unresponsive and staring at the ceiling and trembling. He had a fever of 101F at this time. The facility ordered labs and a rapid COVID test (all of which came back normal) and started IV antibiotics. A few hours later, patient began bleeding from his eyes, nose, and mouth and was sent to the local ER. The patient refused being admitted to the ICU for possible sepsis/hemorrhage and died the following day on 1/3/2021. All healthcare professionals involved agreed that this was not likely due to the vaccine, but needed to be reported nonetheless."
	"0974443-1"	"0974443-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"Patient received Moderna COVID vaccine on 12/30/2020 at a Pharmacy clinic where he was a resident. Nurses at the facility reported that he was responsive and showed no signs of any adverse effects until 1/2/2021 when he was observed slightly unresponsive and staring at the ceiling and trembling. He had a fever of 101F at this time. The facility ordered labs and a rapid COVID test (all of which came back normal) and started IV antibiotics. A few hours later, patient began bleeding from his eyes, nose, and mouth and was sent to the local ER. The patient refused being admitted to the ICU for possible sepsis/hemorrhage and died the following day on 1/3/2021. All healthcare professionals involved agreed that this was not likely due to the vaccine, but needed to be reported nonetheless."
	"0981406-1"	"0981406-1"	"CEREBROVASCULAR ACCIDENT"	"10008190"	"65-79 years"	"65-79"	"Stroke, death"
	"0981406-1"	"0981406-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Stroke, death"
	"0992137-1"	"0992137-1"	"BRADYCARDIA"	"10006093"	"65-79 years"	"65-79"	"6 days after vaccine developed bloody diarrhea. Thought to have ischemic colitis but negative evaluation. became hypotensive bradycardic   placed on ventilator. Subsequently was poorly responsive and eventually coded once more and succumbed"
	"0992137-1"	"0992137-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"65-79 years"	"65-79"	"6 days after vaccine developed bloody diarrhea. Thought to have ischemic colitis but negative evaluation. became hypotensive bradycardic   placed on ventilator. Subsequently was poorly responsive and eventually coded once more and succumbed"
	"0992137-1"	"0992137-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"6 days after vaccine developed bloody diarrhea. Thought to have ischemic colitis but negative evaluation. became hypotensive bradycardic   placed on ventilator. Subsequently was poorly responsive and eventually coded once more and succumbed"
	"0992137-1"	"0992137-1"	"DIARRHOEA HAEMORRHAGIC"	"10012741"	"65-79 years"	"65-79"	"6 days after vaccine developed bloody diarrhea. Thought to have ischemic colitis but negative evaluation. became hypotensive bradycardic   placed on ventilator. Subsequently was poorly responsive and eventually coded once more and succumbed"
	"0992137-1"	"0992137-1"	"HYPORESPONSIVE TO STIMULI"	"10071552"	"65-79 years"	"65-79"	"6 days after vaccine developed bloody diarrhea. Thought to have ischemic colitis but negative evaluation. became hypotensive bradycardic   placed on ventilator. Subsequently was poorly responsive and eventually coded once more and succumbed"
	"0992137-1"	"0992137-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	"6 days after vaccine developed bloody diarrhea. Thought to have ischemic colitis but negative evaluation. became hypotensive bradycardic   placed on ventilator. Subsequently was poorly responsive and eventually coded once more and succumbed"
	"0992137-1"	"0992137-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"6 days after vaccine developed bloody diarrhea. Thought to have ischemic colitis but negative evaluation. became hypotensive bradycardic   placed on ventilator. Subsequently was poorly responsive and eventually coded once more and succumbed"
	"0992372-1"	"0992372-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992372-1"	"0992372-1"	"ATROPHY"	"10003694"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992372-1"	"0992372-1"	"CEREBRAL HAEMORRHAGE"	"10008111"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992372-1"	"0992372-1"	"CEREBRAL SMALL VESSEL ISCHAEMIC DISEASE"	"10070878"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992372-1"	"0992372-1"	"CHEST X-RAY NORMAL"	"10008500"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992372-1"	"0992372-1"	"COMPUTERISED TOMOGRAM HEAD NORMAL"	"10072167"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992372-1"	"0992372-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992372-1"	"0992372-1"	"EMBOLIC CEREBELLAR INFARCTION"	"10084072"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992372-1"	"0992372-1"	"EMBOLIC CEREBRAL INFARCTION"	"10060839"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992372-1"	"0992372-1"	"ERYTHEMA"	"10015150"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992372-1"	"0992372-1"	"LABORATORY TEST NORMAL"	"10054052"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992372-1"	"0992372-1"	"MAGNETIC RESONANCE IMAGING BRAIN"	"10083128"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992372-1"	"0992372-1"	"MAGNETIC RESONANCE IMAGING BRAIN ABNORMAL"	"10083130"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992372-1"	"0992372-1"	"MENTAL STATUS CHANGES"	"10048294"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992372-1"	"0992372-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992372-1"	"0992372-1"	"TROPONIN INCREASED"	"10058267"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992372-1"	"0992372-1"	"WHITE BLOOD CELL COUNT INCREASED"	"10047943"	"65-79 years"	"65-79"	""This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600.  Within one hour, the patient developed altered mental status and increasing weakness.  She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94.  Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63.  Head CT negative.  Physical exam was only notable for 'slight superficial erythema over distal right forearm and dorsal hand. No significant edema.' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR.  She was admitted for monitoring given continued altered mental status/weakness.  The next day, she continued to show no improvement, so a head MRI was ordered.  MRI showed "" 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2.  Minimal right parietal petechial hemorrhage. 3.  Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia  ""  Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis.  The patient's advanced dementia and timeline preclude other intervention.  The patient's status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence).  It was reported that date of death was 1/24/21.""
	"0992571-1"	"0992571-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Patient's wife called the physician's office with increasing SOB.  MD advised that the patient go to the ED.  While dressing, the patient became unresponsive, 911 called.  Patient expired in ED."
	"0992571-1"	"0992571-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient's wife called the physician's office with increasing SOB.  MD advised that the patient go to the ED.  While dressing, the patient became unresponsive, 911 called.  Patient expired in ED."
	"0992571-1"	"0992571-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient's wife called the physician's office with increasing SOB.  MD advised that the patient go to the ED.  While dressing, the patient became unresponsive, 911 called.  Patient expired in ED."
	"0992571-1"	"0992571-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"Patient's wife called the physician's office with increasing SOB.  MD advised that the patient go to the ED.  While dressing, the patient became unresponsive, 911 called.  Patient expired in ED."
	"1000739-1"	"1000739-1"	"DYSKINESIA"	"10013916"	"65-79 years"	"65-79"	"Approximately 10 minutes after receiving the COVID- 19 vaccine resident displayed seizure activity, staring straight ahead and strong allover muscle jerking of both the up and lower extremities, color became gray, activity lasted approximately 3 minutes, resident then became relaxed, color returned to normal, BP-140/80, 97.8, 60, 16, sleeping the remainder of the shift,. Resident continued to decline until resident CTB on 1/19/21"
	"1000739-1"	"1000739-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Approximately 10 minutes after receiving the COVID- 19 vaccine resident displayed seizure activity, staring straight ahead and strong allover muscle jerking of both the up and lower extremities, color became gray, activity lasted approximately 3 minutes, resident then became relaxed, color returned to normal, BP-140/80, 97.8, 60, 16, sleeping the remainder of the shift,. Resident continued to decline until resident CTB on 1/19/21"
	"1000739-1"	"1000739-1"	"INFLUENZA VIRUS TEST"	"10070715"	"65-79 years"	"65-79"	"Approximately 10 minutes after receiving the COVID- 19 vaccine resident displayed seizure activity, staring straight ahead and strong allover muscle jerking of both the up and lower extremities, color became gray, activity lasted approximately 3 minutes, resident then became relaxed, color returned to normal, BP-140/80, 97.8, 60, 16, sleeping the remainder of the shift,. Resident continued to decline until resident CTB on 1/19/21"
	"1000739-1"	"1000739-1"	"LABORATORY TEST"	"10059938"	"65-79 years"	"65-79"	"Approximately 10 minutes after receiving the COVID- 19 vaccine resident displayed seizure activity, staring straight ahead and strong allover muscle jerking of both the up and lower extremities, color became gray, activity lasted approximately 3 minutes, resident then became relaxed, color returned to normal, BP-140/80, 97.8, 60, 16, sleeping the remainder of the shift,. Resident continued to decline until resident CTB on 1/19/21"
	"1000739-1"	"1000739-1"	"MUSCLE TWITCHING"	"10028347"	"65-79 years"	"65-79"	"Approximately 10 minutes after receiving the COVID- 19 vaccine resident displayed seizure activity, staring straight ahead and strong allover muscle jerking of both the up and lower extremities, color became gray, activity lasted approximately 3 minutes, resident then became relaxed, color returned to normal, BP-140/80, 97.8, 60, 16, sleeping the remainder of the shift,. Resident continued to decline until resident CTB on 1/19/21"
	"1000739-1"	"1000739-1"	"PALLOR"	"10033546"	"65-79 years"	"65-79"	"Approximately 10 minutes after receiving the COVID- 19 vaccine resident displayed seizure activity, staring straight ahead and strong allover muscle jerking of both the up and lower extremities, color became gray, activity lasted approximately 3 minutes, resident then became relaxed, color returned to normal, BP-140/80, 97.8, 60, 16, sleeping the remainder of the shift,. Resident continued to decline until resident CTB on 1/19/21"
	"1000739-1"	"1000739-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	"Approximately 10 minutes after receiving the COVID- 19 vaccine resident displayed seizure activity, staring straight ahead and strong allover muscle jerking of both the up and lower extremities, color became gray, activity lasted approximately 3 minutes, resident then became relaxed, color returned to normal, BP-140/80, 97.8, 60, 16, sleeping the remainder of the shift,. Resident continued to decline until resident CTB on 1/19/21"
	"1000739-1"	"1000739-1"	"SEIZURE"	"10039906"	"65-79 years"	"65-79"	"Approximately 10 minutes after receiving the COVID- 19 vaccine resident displayed seizure activity, staring straight ahead and strong allover muscle jerking of both the up and lower extremities, color became gray, activity lasted approximately 3 minutes, resident then became relaxed, color returned to normal, BP-140/80, 97.8, 60, 16, sleeping the remainder of the shift,. Resident continued to decline until resident CTB on 1/19/21"
	"1000739-1"	"1000739-1"	"SKIN DISCOLOURATION"	"10040829"	"65-79 years"	"65-79"	"Approximately 10 minutes after receiving the COVID- 19 vaccine resident displayed seizure activity, staring straight ahead and strong allover muscle jerking of both the up and lower extremities, color became gray, activity lasted approximately 3 minutes, resident then became relaxed, color returned to normal, BP-140/80, 97.8, 60, 16, sleeping the remainder of the shift,. Resident continued to decline until resident CTB on 1/19/21"
	"1000739-1"	"1000739-1"	"STARING"	"10041953"	"65-79 years"	"65-79"	"Approximately 10 minutes after receiving the COVID- 19 vaccine resident displayed seizure activity, staring straight ahead and strong allover muscle jerking of both the up and lower extremities, color became gray, activity lasted approximately 3 minutes, resident then became relaxed, color returned to normal, BP-140/80, 97.8, 60, 16, sleeping the remainder of the shift,. Resident continued to decline until resident CTB on 1/19/21"
	"1002187-1"	"1002187-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"65-79 years"	"65-79"	"PATIENT WAS IN CLINIC FOR 1ST CLINIC. WAS DISCHARGED BEFORE OUR 2ND CLINIC. HE CAME BACK TO OBTAIN HIS 2ND SHOT. WE WENT OUT TO THE CAR GAVE SHOT. THE NEXT DAY TO MY KNOWLEDGE, HE STARTED CODING AT HOME. AMBULANCE WAS CALLED AND HE CONTINUED TO CODE. THE AMBULANCE CREW TRIED CPR FOR 30 MINS WITH NO LUCK. PATIENT PASSED 2-3-21."
	"1002187-1"	"1002187-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"PATIENT WAS IN CLINIC FOR 1ST CLINIC. WAS DISCHARGED BEFORE OUR 2ND CLINIC. HE CAME BACK TO OBTAIN HIS 2ND SHOT. WE WENT OUT TO THE CAR GAVE SHOT. THE NEXT DAY TO MY KNOWLEDGE, HE STARTED CODING AT HOME. AMBULANCE WAS CALLED AND HE CONTINUED TO CODE. THE AMBULANCE CREW TRIED CPR FOR 30 MINS WITH NO LUCK. PATIENT PASSED 2-3-21."
	"1002187-1"	"1002187-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"PATIENT WAS IN CLINIC FOR 1ST CLINIC. WAS DISCHARGED BEFORE OUR 2ND CLINIC. HE CAME BACK TO OBTAIN HIS 2ND SHOT. WE WENT OUT TO THE CAR GAVE SHOT. THE NEXT DAY TO MY KNOWLEDGE, HE STARTED CODING AT HOME. AMBULANCE WAS CALLED AND HE CONTINUED TO CODE. THE AMBULANCE CREW TRIED CPR FOR 30 MINS WITH NO LUCK. PATIENT PASSED 2-3-21."
	"1007310-1"	"1007310-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"view     2/5/2021 09:23 e Progress Note Note Text: Patient passed away in the facility this morning.  view     2/5/2021 08:39 Orders - Administration Note Note Text: Resident passed.  view     2/5/2021 08:33 Nurses Note Note Text: Body released to funeral home at this time. Personal effects sent with resident include: 1 pair of glasses, 1 yellow wedding band, 1silver spoon ring, 1 ring with black and clear stones. Resident has own teeth  view     2/5/2021 08:32 Nurses Note Note Text: cause of death per CRNP failure to thrive.  view     2/5/2021 07:44 Orders - Administration Note Note Text: Take and document temp & PO2  every 4 hours for MONITORING  Resident passed.  view     2/5/2021 06:49 Nurses Note Note Text: Son returned call and was updated of resident's passing this am  view     2/5/2021 06:33 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Unknown  Resident expired @ 0604 [linked]  view     2/5/2021 06:06 Nurses Note Note Text: Res found without pulse or respirations. Pronounced at 0604. Updated. N/o's for RN to pronounce, release body to funeral home, dispose of medications per facility policy. Daughter updated. Funeral Home called to release body.  view     2/5/2021 05:26 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Pulse ox 60% on O2 @ 5L/min via mask. Resps 44 per minute.  view     2/5/2021 01:57 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/5/2021 00:52 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Residents resps are 40 per minute, pulse ox 76% on O2 @ 5L/min via mask. Resps are labored, shallow and rapid.  view     2/5/2021 00:48 Nurses Note Note Text: Nonresponsive to verbal and tactile stimulation. Appears comfortable.  view     2/4/2021 22:01 Nurses Note Note Text: Resident resting comfortably, breathing becoming increasingly shallow, wearing O2 via mask at 5L via mask, no dyspnea noted, feet are mottled, oral and peri care provided Q2H. No s/s of pain or discomfort.  view     2/4/2021 21:40 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective [linked]  view     2/4/2021 19:32 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  medicated for air hunger, RR 28 to 32/ min  view     2/4/2021 19:22 Nurses Note Note Text: Daughter updated on N/O to increase Morphine Sulfate 20mg/mL 0.25mL to Q2H prn from Q6H prn.  view     2/4/2021 18:06 Nurses Note Note Text: POA Daughter and daughter aware of residents current condition.  view     2/4/2021 11:58 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/4/2021 11:13 Nurses Note Note Text: Pt. noted to be lethargic at this time. Does respond to verbal and tactile stimuli by opening her eyes but non verbal currently. Skin warm and dry. No mottling or apnea observed at this time. O2 sat 88% with O2 at 2 LPM via n/c. On increased to 3 LPM via mask as pt. noted to be mouth breathing. Respirations 28. F/U O2 sat 93%. HOB elevated. Pt. medicated with morphine by LPN. Daughter updated on pt.'s condition. Does not want pt. sent out to hospital and would like comfort measures to continue. Daughter also in agreement with delay in d/c d/t pt.'s condition.CRNP updated on pt.'s condition, delay in d/c and daughter's wishes. No n/o's at this time.  view     2/4/2021 10:56 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  Resident showing s/s of discomfort. SOB at this time and high respirations. Repositioned, changed for incontinence care and mouth care provided.    view     2/4/2021 10:34  Progress Note Note Text: Spoke with RN regarding change in condition. Updated Sr Living regarding change. Recommendation to cancel d/c/transfer for today, see how resident does through the weekend and re-evaluate on Monday. Daughter updated on cancellation of d/c today.  view     2/4/2021 10:04 Nurses Note Note Text: Daughter aware that resident's O2 sat was 88% on room air on 3-11 shift and that oxygen was applied via nasal cannula.  view     2/4/2021 10:03 Nurses Note Note Text: N/O: Discharge 2/4/21 with scripts to Sr. Living. Daughter aware.  view     2/4/2021 09:53 Nurses Note Note Text: Pt. to be d/c'd to another facility this am as per MD order. Pt. alert and responsive. Skin assessment done as per facility policy. No pressure areas noted at this time. No s/sx of pain or discomfort observed at this time. V.S. 97.0 67 20 O2 sat 95% with O2 at 2 LPM via n/c.  view     2/4/2021 07:45 Nurses Note Note Text: Resident seen by Dr. for discharge. Orders pending at this time.  view     2/4/2021 07:36 Nurses Note Note Text: CRNP and Dr. updated on O2 sat 88% on RA with f/u of 93% with O2 on at 2 LPM as well as rest of VS, 3-11 shift 2/3/21. No n/o's at this time.  view     2/3/2021 21:17 Nurses Note Note Text: Resident Sp02 88% on RA. Pulse 124. Respirations 40. PRN morphine given and O2 applied via NC at 2L/min. After recheck pulse ox up to 93%, pulse 100, and respirations 22. Resident appears comfortable at this time.  view     2/3/2021 20:05 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective [linked]  view     2/3/2021 19:48 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN given for SOB after elevation of HOB not effective.  view     2/3/2021 11:51 Nurses Note Note Text: CRNP updated rapid COVID test done for d/c tomorrow was negative. No n/o's at this time.  view     2/3/2021 11:44 Nurses Note Note Text: Daughter notified of rapid covid swab being negative.  view     2/3/2021 09:50 Orders - Administration Note Note Text: Obtain Rapid Covid test on 2/3/2021 for discharge. Please give copy of results to Social Worker  every day shift for covid testing for 1 Day  Completed and negative.  view     2/3/2021 08:45 Skilled Nursing Note Reason for skilled service: Therapy  describe skilled service: Nursing, therapy  assessment: V.S. 97.8 79 18 138/84  Orientation: Oriented to self only.  Oxygen: O2 sat 94% on RA  Edema: Trace edema noted BLE. Pedal pulses present.  Pain: Denies pain or discomfort at this time.  Nursing note: Pt. alert and responsive. Skin warm and dry. Lung sounds diminished. No respiratory distress observed at this time. Abdomen soft. BS+ in all 4 quads. Continent/Incontinent of B&B. 1 assist with ambulation, transfers. 1 assist with ADL's. Working with therapy on gait training, therapeutic exercise, therapeutic activities & neuromuscular reeducation.  view     2/2/2021 14:37 Progress Note Note Text: Per health professional at Sr Living, prepared to accept patient to their Memory Care Unit 2/4. Transportation arranged for 11 AM per family request. Daughter (POA) updated on d/c time on 2/4/21. Facility requesting rapid COVID test completed prior to d/c and results sent to them. All other information sent for continuity of care."
	"1007310-1"	"1007310-1"	"DRY SKIN"	"10013786"	"65-79 years"	"65-79"	"view     2/5/2021 09:23 e Progress Note Note Text: Patient passed away in the facility this morning.  view     2/5/2021 08:39 Orders - Administration Note Note Text: Resident passed.  view     2/5/2021 08:33 Nurses Note Note Text: Body released to funeral home at this time. Personal effects sent with resident include: 1 pair of glasses, 1 yellow wedding band, 1silver spoon ring, 1 ring with black and clear stones. Resident has own teeth  view     2/5/2021 08:32 Nurses Note Note Text: cause of death per CRNP failure to thrive.  view     2/5/2021 07:44 Orders - Administration Note Note Text: Take and document temp & PO2  every 4 hours for MONITORING  Resident passed.  view     2/5/2021 06:49 Nurses Note Note Text: Son returned call and was updated of resident's passing this am  view     2/5/2021 06:33 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Unknown  Resident expired @ 0604 [linked]  view     2/5/2021 06:06 Nurses Note Note Text: Res found without pulse or respirations. Pronounced at 0604. Updated. N/o's for RN to pronounce, release body to funeral home, dispose of medications per facility policy. Daughter updated. Funeral Home called to release body.  view     2/5/2021 05:26 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Pulse ox 60% on O2 @ 5L/min via mask. Resps 44 per minute.  view     2/5/2021 01:57 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/5/2021 00:52 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Residents resps are 40 per minute, pulse ox 76% on O2 @ 5L/min via mask. Resps are labored, shallow and rapid.  view     2/5/2021 00:48 Nurses Note Note Text: Nonresponsive to verbal and tactile stimulation. Appears comfortable.  view     2/4/2021 22:01 Nurses Note Note Text: Resident resting comfortably, breathing becoming increasingly shallow, wearing O2 via mask at 5L via mask, no dyspnea noted, feet are mottled, oral and peri care provided Q2H. No s/s of pain or discomfort.  view     2/4/2021 21:40 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective [linked]  view     2/4/2021 19:32 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  medicated for air hunger, RR 28 to 32/ min  view     2/4/2021 19:22 Nurses Note Note Text: Daughter updated on N/O to increase Morphine Sulfate 20mg/mL 0.25mL to Q2H prn from Q6H prn.  view     2/4/2021 18:06 Nurses Note Note Text: POA Daughter and daughter aware of residents current condition.  view     2/4/2021 11:58 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/4/2021 11:13 Nurses Note Note Text: Pt. noted to be lethargic at this time. Does respond to verbal and tactile stimuli by opening her eyes but non verbal currently. Skin warm and dry. No mottling or apnea observed at this time. O2 sat 88% with O2 at 2 LPM via n/c. On increased to 3 LPM via mask as pt. noted to be mouth breathing. Respirations 28. F/U O2 sat 93%. HOB elevated. Pt. medicated with morphine by LPN. Daughter updated on pt.'s condition. Does not want pt. sent out to hospital and would like comfort measures to continue. Daughter also in agreement with delay in d/c d/t pt.'s condition.CRNP updated on pt.'s condition, delay in d/c and daughter's wishes. No n/o's at this time.  view     2/4/2021 10:56 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  Resident showing s/s of discomfort. SOB at this time and high respirations. Repositioned, changed for incontinence care and mouth care provided.    view     2/4/2021 10:34  Progress Note Note Text: Spoke with RN regarding change in condition. Updated Sr Living regarding change. Recommendation to cancel d/c/transfer for today, see how resident does through the weekend and re-evaluate on Monday. Daughter updated on cancellation of d/c today.  view     2/4/2021 10:04 Nurses Note Note Text: Daughter aware that resident's O2 sat was 88% on room air on 3-11 shift and that oxygen was applied via nasal cannula.  view     2/4/2021 10:03 Nurses Note Note Text: N/O: Discharge 2/4/21 with scripts to Sr. Living. Daughter aware.  view     2/4/2021 09:53 Nurses Note Note Text: Pt. to be d/c'd to another facility this am as per MD order. Pt. alert and responsive. Skin assessment done as per facility policy. No pressure areas noted at this time. No s/sx of pain or discomfort observed at this time. V.S. 97.0 67 20 O2 sat 95% with O2 at 2 LPM via n/c.  view     2/4/2021 07:45 Nurses Note Note Text: Resident seen by Dr. for discharge. Orders pending at this time.  view     2/4/2021 07:36 Nurses Note Note Text: CRNP and Dr. updated on O2 sat 88% on RA with f/u of 93% with O2 on at 2 LPM as well as rest of VS, 3-11 shift 2/3/21. No n/o's at this time.  view     2/3/2021 21:17 Nurses Note Note Text: Resident Sp02 88% on RA. Pulse 124. Respirations 40. PRN morphine given and O2 applied via NC at 2L/min. After recheck pulse ox up to 93%, pulse 100, and respirations 22. Resident appears comfortable at this time.  view     2/3/2021 20:05 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective [linked]  view     2/3/2021 19:48 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN given for SOB after elevation of HOB not effective.  view     2/3/2021 11:51 Nurses Note Note Text: CRNP updated rapid COVID test done for d/c tomorrow was negative. No n/o's at this time.  view     2/3/2021 11:44 Nurses Note Note Text: Daughter notified of rapid covid swab being negative.  view     2/3/2021 09:50 Orders - Administration Note Note Text: Obtain Rapid Covid test on 2/3/2021 for discharge. Please give copy of results to Social Worker  every day shift for covid testing for 1 Day  Completed and negative.  view     2/3/2021 08:45 Skilled Nursing Note Reason for skilled service: Therapy  describe skilled service: Nursing, therapy  assessment: V.S. 97.8 79 18 138/84  Orientation: Oriented to self only.  Oxygen: O2 sat 94% on RA  Edema: Trace edema noted BLE. Pedal pulses present.  Pain: Denies pain or discomfort at this time.  Nursing note: Pt. alert and responsive. Skin warm and dry. Lung sounds diminished. No respiratory distress observed at this time. Abdomen soft. BS+ in all 4 quads. Continent/Incontinent of B&B. 1 assist with ambulation, transfers. 1 assist with ADL's. Working with therapy on gait training, therapeutic exercise, therapeutic activities & neuromuscular reeducation.  view     2/2/2021 14:37 Progress Note Note Text: Per health professional at Sr Living, prepared to accept patient to their Memory Care Unit 2/4. Transportation arranged for 11 AM per family request. Daughter (POA) updated on d/c time on 2/4/21. Facility requesting rapid COVID test completed prior to d/c and results sent to them. All other information sent for continuity of care."
	"1007310-1"	"1007310-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"view     2/5/2021 09:23 e Progress Note Note Text: Patient passed away in the facility this morning.  view     2/5/2021 08:39 Orders - Administration Note Note Text: Resident passed.  view     2/5/2021 08:33 Nurses Note Note Text: Body released to funeral home at this time. Personal effects sent with resident include: 1 pair of glasses, 1 yellow wedding band, 1silver spoon ring, 1 ring with black and clear stones. Resident has own teeth  view     2/5/2021 08:32 Nurses Note Note Text: cause of death per CRNP failure to thrive.  view     2/5/2021 07:44 Orders - Administration Note Note Text: Take and document temp & PO2  every 4 hours for MONITORING  Resident passed.  view     2/5/2021 06:49 Nurses Note Note Text: Son returned call and was updated of resident's passing this am  view     2/5/2021 06:33 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Unknown  Resident expired @ 0604 [linked]  view     2/5/2021 06:06 Nurses Note Note Text: Res found without pulse or respirations. Pronounced at 0604. Updated. N/o's for RN to pronounce, release body to funeral home, dispose of medications per facility policy. Daughter updated. Funeral Home called to release body.  view     2/5/2021 05:26 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Pulse ox 60% on O2 @ 5L/min via mask. Resps 44 per minute.  view     2/5/2021 01:57 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/5/2021 00:52 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Residents resps are 40 per minute, pulse ox 76% on O2 @ 5L/min via mask. Resps are labored, shallow and rapid.  view     2/5/2021 00:48 Nurses Note Note Text: Nonresponsive to verbal and tactile stimulation. Appears comfortable.  view     2/4/2021 22:01 Nurses Note Note Text: Resident resting comfortably, breathing becoming increasingly shallow, wearing O2 via mask at 5L via mask, no dyspnea noted, feet are mottled, oral and peri care provided Q2H. No s/s of pain or discomfort.  view     2/4/2021 21:40 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective [linked]  view     2/4/2021 19:32 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  medicated for air hunger, RR 28 to 32/ min  view     2/4/2021 19:22 Nurses Note Note Text: Daughter updated on N/O to increase Morphine Sulfate 20mg/mL 0.25mL to Q2H prn from Q6H prn.  view     2/4/2021 18:06 Nurses Note Note Text: POA Daughter and daughter aware of residents current condition.  view     2/4/2021 11:58 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/4/2021 11:13 Nurses Note Note Text: Pt. noted to be lethargic at this time. Does respond to verbal and tactile stimuli by opening her eyes but non verbal currently. Skin warm and dry. No mottling or apnea observed at this time. O2 sat 88% with O2 at 2 LPM via n/c. On increased to 3 LPM via mask as pt. noted to be mouth breathing. Respirations 28. F/U O2 sat 93%. HOB elevated. Pt. medicated with morphine by LPN. Daughter updated on pt.'s condition. Does not want pt. sent out to hospital and would like comfort measures to continue. Daughter also in agreement with delay in d/c d/t pt.'s condition.CRNP updated on pt.'s condition, delay in d/c and daughter's wishes. No n/o's at this time.  view     2/4/2021 10:56 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  Resident showing s/s of discomfort. SOB at this time and high respirations. Repositioned, changed for incontinence care and mouth care provided.    view     2/4/2021 10:34  Progress Note Note Text: Spoke with RN regarding change in condition. Updated Sr Living regarding change. Recommendation to cancel d/c/transfer for today, see how resident does through the weekend and re-evaluate on Monday. Daughter updated on cancellation of d/c today.  view     2/4/2021 10:04 Nurses Note Note Text: Daughter aware that resident's O2 sat was 88% on room air on 3-11 shift and that oxygen was applied via nasal cannula.  view     2/4/2021 10:03 Nurses Note Note Text: N/O: Discharge 2/4/21 with scripts to Sr. Living. Daughter aware.  view     2/4/2021 09:53 Nurses Note Note Text: Pt. to be d/c'd to another facility this am as per MD order. Pt. alert and responsive. Skin assessment done as per facility policy. No pressure areas noted at this time. No s/sx of pain or discomfort observed at this time. V.S. 97.0 67 20 O2 sat 95% with O2 at 2 LPM via n/c.  view     2/4/2021 07:45 Nurses Note Note Text: Resident seen by Dr. for discharge. Orders pending at this time.  view     2/4/2021 07:36 Nurses Note Note Text: CRNP and Dr. updated on O2 sat 88% on RA with f/u of 93% with O2 on at 2 LPM as well as rest of VS, 3-11 shift 2/3/21. No n/o's at this time.  view     2/3/2021 21:17 Nurses Note Note Text: Resident Sp02 88% on RA. Pulse 124. Respirations 40. PRN morphine given and O2 applied via NC at 2L/min. After recheck pulse ox up to 93%, pulse 100, and respirations 22. Resident appears comfortable at this time.  view     2/3/2021 20:05 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective [linked]  view     2/3/2021 19:48 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN given for SOB after elevation of HOB not effective.  view     2/3/2021 11:51 Nurses Note Note Text: CRNP updated rapid COVID test done for d/c tomorrow was negative. No n/o's at this time.  view     2/3/2021 11:44 Nurses Note Note Text: Daughter notified of rapid covid swab being negative.  view     2/3/2021 09:50 Orders - Administration Note Note Text: Obtain Rapid Covid test on 2/3/2021 for discharge. Please give copy of results to Social Worker  every day shift for covid testing for 1 Day  Completed and negative.  view     2/3/2021 08:45 Skilled Nursing Note Reason for skilled service: Therapy  describe skilled service: Nursing, therapy  assessment: V.S. 97.8 79 18 138/84  Orientation: Oriented to self only.  Oxygen: O2 sat 94% on RA  Edema: Trace edema noted BLE. Pedal pulses present.  Pain: Denies pain or discomfort at this time.  Nursing note: Pt. alert and responsive. Skin warm and dry. Lung sounds diminished. No respiratory distress observed at this time. Abdomen soft. BS+ in all 4 quads. Continent/Incontinent of B&B. 1 assist with ambulation, transfers. 1 assist with ADL's. Working with therapy on gait training, therapeutic exercise, therapeutic activities & neuromuscular reeducation.  view     2/2/2021 14:37 Progress Note Note Text: Per health professional at Sr Living, prepared to accept patient to their Memory Care Unit 2/4. Transportation arranged for 11 AM per family request. Daughter (POA) updated on d/c time on 2/4/21. Facility requesting rapid COVID test completed prior to d/c and results sent to them. All other information sent for continuity of care."
	"1007310-1"	"1007310-1"	"FAILURE TO THRIVE"	"10016165"	"65-79 years"	"65-79"	"view     2/5/2021 09:23 e Progress Note Note Text: Patient passed away in the facility this morning.  view     2/5/2021 08:39 Orders - Administration Note Note Text: Resident passed.  view     2/5/2021 08:33 Nurses Note Note Text: Body released to funeral home at this time. Personal effects sent with resident include: 1 pair of glasses, 1 yellow wedding band, 1silver spoon ring, 1 ring with black and clear stones. Resident has own teeth  view     2/5/2021 08:32 Nurses Note Note Text: cause of death per CRNP failure to thrive.  view     2/5/2021 07:44 Orders - Administration Note Note Text: Take and document temp & PO2  every 4 hours for MONITORING  Resident passed.  view     2/5/2021 06:49 Nurses Note Note Text: Son returned call and was updated of resident's passing this am  view     2/5/2021 06:33 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Unknown  Resident expired @ 0604 [linked]  view     2/5/2021 06:06 Nurses Note Note Text: Res found without pulse or respirations. Pronounced at 0604. Updated. N/o's for RN to pronounce, release body to funeral home, dispose of medications per facility policy. Daughter updated. Funeral Home called to release body.  view     2/5/2021 05:26 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Pulse ox 60% on O2 @ 5L/min via mask. Resps 44 per minute.  view     2/5/2021 01:57 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/5/2021 00:52 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Residents resps are 40 per minute, pulse ox 76% on O2 @ 5L/min via mask. Resps are labored, shallow and rapid.  view     2/5/2021 00:48 Nurses Note Note Text: Nonresponsive to verbal and tactile stimulation. Appears comfortable.  view     2/4/2021 22:01 Nurses Note Note Text: Resident resting comfortably, breathing becoming increasingly shallow, wearing O2 via mask at 5L via mask, no dyspnea noted, feet are mottled, oral and peri care provided Q2H. No s/s of pain or discomfort.  view     2/4/2021 21:40 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective [linked]  view     2/4/2021 19:32 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  medicated for air hunger, RR 28 to 32/ min  view     2/4/2021 19:22 Nurses Note Note Text: Daughter updated on N/O to increase Morphine Sulfate 20mg/mL 0.25mL to Q2H prn from Q6H prn.  view     2/4/2021 18:06 Nurses Note Note Text: POA Daughter and daughter aware of residents current condition.  view     2/4/2021 11:58 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/4/2021 11:13 Nurses Note Note Text: Pt. noted to be lethargic at this time. Does respond to verbal and tactile stimuli by opening her eyes but non verbal currently. Skin warm and dry. No mottling or apnea observed at this time. O2 sat 88% with O2 at 2 LPM via n/c. On increased to 3 LPM via mask as pt. noted to be mouth breathing. Respirations 28. F/U O2 sat 93%. HOB elevated. Pt. medicated with morphine by LPN. Daughter updated on pt.'s condition. Does not want pt. sent out to hospital and would like comfort measures to continue. Daughter also in agreement with delay in d/c d/t pt.'s condition.CRNP updated on pt.'s condition, delay in d/c and daughter's wishes. No n/o's at this time.  view     2/4/2021 10:56 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  Resident showing s/s of discomfort. SOB at this time and high respirations. Repositioned, changed for incontinence care and mouth care provided.    view     2/4/2021 10:34  Progress Note Note Text: Spoke with RN regarding change in condition. Updated Sr Living regarding change. Recommendation to cancel d/c/transfer for today, see how resident does through the weekend and re-evaluate on Monday. Daughter updated on cancellation of d/c today.  view     2/4/2021 10:04 Nurses Note Note Text: Daughter aware that resident's O2 sat was 88% on room air on 3-11 shift and that oxygen was applied via nasal cannula.  view     2/4/2021 10:03 Nurses Note Note Text: N/O: Discharge 2/4/21 with scripts to Sr. Living. Daughter aware.  view     2/4/2021 09:53 Nurses Note Note Text: Pt. to be d/c'd to another facility this am as per MD order. Pt. alert and responsive. Skin assessment done as per facility policy. No pressure areas noted at this time. No s/sx of pain or discomfort observed at this time. V.S. 97.0 67 20 O2 sat 95% with O2 at 2 LPM via n/c.  view     2/4/2021 07:45 Nurses Note Note Text: Resident seen by Dr. for discharge. Orders pending at this time.  view     2/4/2021 07:36 Nurses Note Note Text: CRNP and Dr. updated on O2 sat 88% on RA with f/u of 93% with O2 on at 2 LPM as well as rest of VS, 3-11 shift 2/3/21. No n/o's at this time.  view     2/3/2021 21:17 Nurses Note Note Text: Resident Sp02 88% on RA. Pulse 124. Respirations 40. PRN morphine given and O2 applied via NC at 2L/min. After recheck pulse ox up to 93%, pulse 100, and respirations 22. Resident appears comfortable at this time.  view     2/3/2021 20:05 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective [linked]  view     2/3/2021 19:48 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN given for SOB after elevation of HOB not effective.  view     2/3/2021 11:51 Nurses Note Note Text: CRNP updated rapid COVID test done for d/c tomorrow was negative. No n/o's at this time.  view     2/3/2021 11:44 Nurses Note Note Text: Daughter notified of rapid covid swab being negative.  view     2/3/2021 09:50 Orders - Administration Note Note Text: Obtain Rapid Covid test on 2/3/2021 for discharge. Please give copy of results to Social Worker  every day shift for covid testing for 1 Day  Completed and negative.  view     2/3/2021 08:45 Skilled Nursing Note Reason for skilled service: Therapy  describe skilled service: Nursing, therapy  assessment: V.S. 97.8 79 18 138/84  Orientation: Oriented to self only.  Oxygen: O2 sat 94% on RA  Edema: Trace edema noted BLE. Pedal pulses present.  Pain: Denies pain or discomfort at this time.  Nursing note: Pt. alert and responsive. Skin warm and dry. Lung sounds diminished. No respiratory distress observed at this time. Abdomen soft. BS+ in all 4 quads. Continent/Incontinent of B&B. 1 assist with ambulation, transfers. 1 assist with ADL's. Working with therapy on gait training, therapeutic exercise, therapeutic activities & neuromuscular reeducation.  view     2/2/2021 14:37 Progress Note Note Text: Per health professional at Sr Living, prepared to accept patient to their Memory Care Unit 2/4. Transportation arranged for 11 AM per family request. Daughter (POA) updated on d/c time on 2/4/21. Facility requesting rapid COVID test completed prior to d/c and results sent to them. All other information sent for continuity of care."
	"1007310-1"	"1007310-1"	"HYPOPNOEA"	"10021079"	"65-79 years"	"65-79"	"view     2/5/2021 09:23 e Progress Note Note Text: Patient passed away in the facility this morning.  view     2/5/2021 08:39 Orders - Administration Note Note Text: Resident passed.  view     2/5/2021 08:33 Nurses Note Note Text: Body released to funeral home at this time. Personal effects sent with resident include: 1 pair of glasses, 1 yellow wedding band, 1silver spoon ring, 1 ring with black and clear stones. Resident has own teeth  view     2/5/2021 08:32 Nurses Note Note Text: cause of death per CRNP failure to thrive.  view     2/5/2021 07:44 Orders - Administration Note Note Text: Take and document temp & PO2  every 4 hours for MONITORING  Resident passed.  view     2/5/2021 06:49 Nurses Note Note Text: Son returned call and was updated of resident's passing this am  view     2/5/2021 06:33 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Unknown  Resident expired @ 0604 [linked]  view     2/5/2021 06:06 Nurses Note Note Text: Res found without pulse or respirations. Pronounced at 0604. Updated. N/o's for RN to pronounce, release body to funeral home, dispose of medications per facility policy. Daughter updated. Funeral Home called to release body.  view     2/5/2021 05:26 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Pulse ox 60% on O2 @ 5L/min via mask. Resps 44 per minute.  view     2/5/2021 01:57 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/5/2021 00:52 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Residents resps are 40 per minute, pulse ox 76% on O2 @ 5L/min via mask. Resps are labored, shallow and rapid.  view     2/5/2021 00:48 Nurses Note Note Text: Nonresponsive to verbal and tactile stimulation. Appears comfortable.  view     2/4/2021 22:01 Nurses Note Note Text: Resident resting comfortably, breathing becoming increasingly shallow, wearing O2 via mask at 5L via mask, no dyspnea noted, feet are mottled, oral and peri care provided Q2H. No s/s of pain or discomfort.  view     2/4/2021 21:40 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective [linked]  view     2/4/2021 19:32 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  medicated for air hunger, RR 28 to 32/ min  view     2/4/2021 19:22 Nurses Note Note Text: Daughter updated on N/O to increase Morphine Sulfate 20mg/mL 0.25mL to Q2H prn from Q6H prn.  view     2/4/2021 18:06 Nurses Note Note Text: POA Daughter and daughter aware of residents current condition.  view     2/4/2021 11:58 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/4/2021 11:13 Nurses Note Note Text: Pt. noted to be lethargic at this time. Does respond to verbal and tactile stimuli by opening her eyes but non verbal currently. Skin warm and dry. No mottling or apnea observed at this time. O2 sat 88% with O2 at 2 LPM via n/c. On increased to 3 LPM via mask as pt. noted to be mouth breathing. Respirations 28. F/U O2 sat 93%. HOB elevated. Pt. medicated with morphine by LPN. Daughter updated on pt.'s condition. Does not want pt. sent out to hospital and would like comfort measures to continue. Daughter also in agreement with delay in d/c d/t pt.'s condition.CRNP updated on pt.'s condition, delay in d/c and daughter's wishes. No n/o's at this time.  view     2/4/2021 10:56 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  Resident showing s/s of discomfort. SOB at this time and high respirations. Repositioned, changed for incontinence care and mouth care provided.    view     2/4/2021 10:34  Progress Note Note Text: Spoke with RN regarding change in condition. Updated Sr Living regarding change. Recommendation to cancel d/c/transfer for today, see how resident does through the weekend and re-evaluate on Monday. Daughter updated on cancellation of d/c today.  view     2/4/2021 10:04 Nurses Note Note Text: Daughter aware that resident's O2 sat was 88% on room air on 3-11 shift and that oxygen was applied via nasal cannula.  view     2/4/2021 10:03 Nurses Note Note Text: N/O: Discharge 2/4/21 with scripts to Sr. Living. Daughter aware.  view     2/4/2021 09:53 Nurses Note Note Text: Pt. to be d/c'd to another facility this am as per MD order. Pt. alert and responsive. Skin assessment done as per facility policy. No pressure areas noted at this time. No s/sx of pain or discomfort observed at this time. V.S. 97.0 67 20 O2 sat 95% with O2 at 2 LPM via n/c.  view     2/4/2021 07:45 Nurses Note Note Text: Resident seen by Dr. for discharge. Orders pending at this time.  view     2/4/2021 07:36 Nurses Note Note Text: CRNP and Dr. updated on O2 sat 88% on RA with f/u of 93% with O2 on at 2 LPM as well as rest of VS, 3-11 shift 2/3/21. No n/o's at this time.  view     2/3/2021 21:17 Nurses Note Note Text: Resident Sp02 88% on RA. Pulse 124. Respirations 40. PRN morphine given and O2 applied via NC at 2L/min. After recheck pulse ox up to 93%, pulse 100, and respirations 22. Resident appears comfortable at this time.  view     2/3/2021 20:05 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective [linked]  view     2/3/2021 19:48 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN given for SOB after elevation of HOB not effective.  view     2/3/2021 11:51 Nurses Note Note Text: CRNP updated rapid COVID test done for d/c tomorrow was negative. No n/o's at this time.  view     2/3/2021 11:44 Nurses Note Note Text: Daughter notified of rapid covid swab being negative.  view     2/3/2021 09:50 Orders - Administration Note Note Text: Obtain Rapid Covid test on 2/3/2021 for discharge. Please give copy of results to Social Worker  every day shift for covid testing for 1 Day  Completed and negative.  view     2/3/2021 08:45 Skilled Nursing Note Reason for skilled service: Therapy  describe skilled service: Nursing, therapy  assessment: V.S. 97.8 79 18 138/84  Orientation: Oriented to self only.  Oxygen: O2 sat 94% on RA  Edema: Trace edema noted BLE. Pedal pulses present.  Pain: Denies pain or discomfort at this time.  Nursing note: Pt. alert and responsive. Skin warm and dry. Lung sounds diminished. No respiratory distress observed at this time. Abdomen soft. BS+ in all 4 quads. Continent/Incontinent of B&B. 1 assist with ambulation, transfers. 1 assist with ADL's. Working with therapy on gait training, therapeutic exercise, therapeutic activities & neuromuscular reeducation.  view     2/2/2021 14:37 Progress Note Note Text: Per health professional at Sr Living, prepared to accept patient to their Memory Care Unit 2/4. Transportation arranged for 11 AM per family request. Daughter (POA) updated on d/c time on 2/4/21. Facility requesting rapid COVID test completed prior to d/c and results sent to them. All other information sent for continuity of care."
	"1007310-1"	"1007310-1"	"LETHARGY"	"10024264"	"65-79 years"	"65-79"	"view     2/5/2021 09:23 e Progress Note Note Text: Patient passed away in the facility this morning.  view     2/5/2021 08:39 Orders - Administration Note Note Text: Resident passed.  view     2/5/2021 08:33 Nurses Note Note Text: Body released to funeral home at this time. Personal effects sent with resident include: 1 pair of glasses, 1 yellow wedding band, 1silver spoon ring, 1 ring with black and clear stones. Resident has own teeth  view     2/5/2021 08:32 Nurses Note Note Text: cause of death per CRNP failure to thrive.  view     2/5/2021 07:44 Orders - Administration Note Note Text: Take and document temp & PO2  every 4 hours for MONITORING  Resident passed.  view     2/5/2021 06:49 Nurses Note Note Text: Son returned call and was updated of resident's passing this am  view     2/5/2021 06:33 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Unknown  Resident expired @ 0604 [linked]  view     2/5/2021 06:06 Nurses Note Note Text: Res found without pulse or respirations. Pronounced at 0604. Updated. N/o's for RN to pronounce, release body to funeral home, dispose of medications per facility policy. Daughter updated. Funeral Home called to release body.  view     2/5/2021 05:26 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Pulse ox 60% on O2 @ 5L/min via mask. Resps 44 per minute.  view     2/5/2021 01:57 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/5/2021 00:52 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Residents resps are 40 per minute, pulse ox 76% on O2 @ 5L/min via mask. Resps are labored, shallow and rapid.  view     2/5/2021 00:48 Nurses Note Note Text: Nonresponsive to verbal and tactile stimulation. Appears comfortable.  view     2/4/2021 22:01 Nurses Note Note Text: Resident resting comfortably, breathing becoming increasingly shallow, wearing O2 via mask at 5L via mask, no dyspnea noted, feet are mottled, oral and peri care provided Q2H. No s/s of pain or discomfort.  view     2/4/2021 21:40 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective [linked]  view     2/4/2021 19:32 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  medicated for air hunger, RR 28 to 32/ min  view     2/4/2021 19:22 Nurses Note Note Text: Daughter updated on N/O to increase Morphine Sulfate 20mg/mL 0.25mL to Q2H prn from Q6H prn.  view     2/4/2021 18:06 Nurses Note Note Text: POA Daughter and daughter aware of residents current condition.  view     2/4/2021 11:58 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/4/2021 11:13 Nurses Note Note Text: Pt. noted to be lethargic at this time. Does respond to verbal and tactile stimuli by opening her eyes but non verbal currently. Skin warm and dry. No mottling or apnea observed at this time. O2 sat 88% with O2 at 2 LPM via n/c. On increased to 3 LPM via mask as pt. noted to be mouth breathing. Respirations 28. F/U O2 sat 93%. HOB elevated. Pt. medicated with morphine by LPN. Daughter updated on pt.'s condition. Does not want pt. sent out to hospital and would like comfort measures to continue. Daughter also in agreement with delay in d/c d/t pt.'s condition.CRNP updated on pt.'s condition, delay in d/c and daughter's wishes. No n/o's at this time.  view     2/4/2021 10:56 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  Resident showing s/s of discomfort. SOB at this time and high respirations. Repositioned, changed for incontinence care and mouth care provided.    view     2/4/2021 10:34  Progress Note Note Text: Spoke with RN regarding change in condition. Updated Sr Living regarding change. Recommendation to cancel d/c/transfer for today, see how resident does through the weekend and re-evaluate on Monday. Daughter updated on cancellation of d/c today.  view     2/4/2021 10:04 Nurses Note Note Text: Daughter aware that resident's O2 sat was 88% on room air on 3-11 shift and that oxygen was applied via nasal cannula.  view     2/4/2021 10:03 Nurses Note Note Text: N/O: Discharge 2/4/21 with scripts to Sr. Living. Daughter aware.  view     2/4/2021 09:53 Nurses Note Note Text: Pt. to be d/c'd to another facility this am as per MD order. Pt. alert and responsive. Skin assessment done as per facility policy. No pressure areas noted at this time. No s/sx of pain or discomfort observed at this time. V.S. 97.0 67 20 O2 sat 95% with O2 at 2 LPM via n/c.  view     2/4/2021 07:45 Nurses Note Note Text: Resident seen by Dr. for discharge. Orders pending at this time.  view     2/4/2021 07:36 Nurses Note Note Text: CRNP and Dr. updated on O2 sat 88% on RA with f/u of 93% with O2 on at 2 LPM as well as rest of VS, 3-11 shift 2/3/21. No n/o's at this time.  view     2/3/2021 21:17 Nurses Note Note Text: Resident Sp02 88% on RA. Pulse 124. Respirations 40. PRN morphine given and O2 applied via NC at 2L/min. After recheck pulse ox up to 93%, pulse 100, and respirations 22. Resident appears comfortable at this time.  view     2/3/2021 20:05 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective [linked]  view     2/3/2021 19:48 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN given for SOB after elevation of HOB not effective.  view     2/3/2021 11:51 Nurses Note Note Text: CRNP updated rapid COVID test done for d/c tomorrow was negative. No n/o's at this time.  view     2/3/2021 11:44 Nurses Note Note Text: Daughter notified of rapid covid swab being negative.  view     2/3/2021 09:50 Orders - Administration Note Note Text: Obtain Rapid Covid test on 2/3/2021 for discharge. Please give copy of results to Social Worker  every day shift for covid testing for 1 Day  Completed and negative.  view     2/3/2021 08:45 Skilled Nursing Note Reason for skilled service: Therapy  describe skilled service: Nursing, therapy  assessment: V.S. 97.8 79 18 138/84  Orientation: Oriented to self only.  Oxygen: O2 sat 94% on RA  Edema: Trace edema noted BLE. Pedal pulses present.  Pain: Denies pain or discomfort at this time.  Nursing note: Pt. alert and responsive. Skin warm and dry. Lung sounds diminished. No respiratory distress observed at this time. Abdomen soft. BS+ in all 4 quads. Continent/Incontinent of B&B. 1 assist with ambulation, transfers. 1 assist with ADL's. Working with therapy on gait training, therapeutic exercise, therapeutic activities & neuromuscular reeducation.  view     2/2/2021 14:37 Progress Note Note Text: Per health professional at Sr Living, prepared to accept patient to their Memory Care Unit 2/4. Transportation arranged for 11 AM per family request. Daughter (POA) updated on d/c time on 2/4/21. Facility requesting rapid COVID test completed prior to d/c and results sent to them. All other information sent for continuity of care."
	"1007310-1"	"1007310-1"	"MOUTH BREATHING"	"10028017"	"65-79 years"	"65-79"	"view     2/5/2021 09:23 e Progress Note Note Text: Patient passed away in the facility this morning.  view     2/5/2021 08:39 Orders - Administration Note Note Text: Resident passed.  view     2/5/2021 08:33 Nurses Note Note Text: Body released to funeral home at this time. Personal effects sent with resident include: 1 pair of glasses, 1 yellow wedding band, 1silver spoon ring, 1 ring with black and clear stones. Resident has own teeth  view     2/5/2021 08:32 Nurses Note Note Text: cause of death per CRNP failure to thrive.  view     2/5/2021 07:44 Orders - Administration Note Note Text: Take and document temp & PO2  every 4 hours for MONITORING  Resident passed.  view     2/5/2021 06:49 Nurses Note Note Text: Son returned call and was updated of resident's passing this am  view     2/5/2021 06:33 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Unknown  Resident expired @ 0604 [linked]  view     2/5/2021 06:06 Nurses Note Note Text: Res found without pulse or respirations. Pronounced at 0604. Updated. N/o's for RN to pronounce, release body to funeral home, dispose of medications per facility policy. Daughter updated. Funeral Home called to release body.  view     2/5/2021 05:26 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Pulse ox 60% on O2 @ 5L/min via mask. Resps 44 per minute.  view     2/5/2021 01:57 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/5/2021 00:52 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Residents resps are 40 per minute, pulse ox 76% on O2 @ 5L/min via mask. Resps are labored, shallow and rapid.  view     2/5/2021 00:48 Nurses Note Note Text: Nonresponsive to verbal and tactile stimulation. Appears comfortable.  view     2/4/2021 22:01 Nurses Note Note Text: Resident resting comfortably, breathing becoming increasingly shallow, wearing O2 via mask at 5L via mask, no dyspnea noted, feet are mottled, oral and peri care provided Q2H. No s/s of pain or discomfort.  view     2/4/2021 21:40 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective [linked]  view     2/4/2021 19:32 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  medicated for air hunger, RR 28 to 32/ min  view     2/4/2021 19:22 Nurses Note Note Text: Daughter updated on N/O to increase Morphine Sulfate 20mg/mL 0.25mL to Q2H prn from Q6H prn.  view     2/4/2021 18:06 Nurses Note Note Text: POA Daughter and daughter aware of residents current condition.  view     2/4/2021 11:58 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/4/2021 11:13 Nurses Note Note Text: Pt. noted to be lethargic at this time. Does respond to verbal and tactile stimuli by opening her eyes but non verbal currently. Skin warm and dry. No mottling or apnea observed at this time. O2 sat 88% with O2 at 2 LPM via n/c. On increased to 3 LPM via mask as pt. noted to be mouth breathing. Respirations 28. F/U O2 sat 93%. HOB elevated. Pt. medicated with morphine by LPN. Daughter updated on pt.'s condition. Does not want pt. sent out to hospital and would like comfort measures to continue. Daughter also in agreement with delay in d/c d/t pt.'s condition.CRNP updated on pt.'s condition, delay in d/c and daughter's wishes. No n/o's at this time.  view     2/4/2021 10:56 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  Resident showing s/s of discomfort. SOB at this time and high respirations. Repositioned, changed for incontinence care and mouth care provided.    view     2/4/2021 10:34  Progress Note Note Text: Spoke with RN regarding change in condition. Updated Sr Living regarding change. Recommendation to cancel d/c/transfer for today, see how resident does through the weekend and re-evaluate on Monday. Daughter updated on cancellation of d/c today.  view     2/4/2021 10:04 Nurses Note Note Text: Daughter aware that resident's O2 sat was 88% on room air on 3-11 shift and that oxygen was applied via nasal cannula.  view     2/4/2021 10:03 Nurses Note Note Text: N/O: Discharge 2/4/21 with scripts to Sr. Living. Daughter aware.  view     2/4/2021 09:53 Nurses Note Note Text: Pt. to be d/c'd to another facility this am as per MD order. Pt. alert and responsive. Skin assessment done as per facility policy. No pressure areas noted at this time. No s/sx of pain or discomfort observed at this time. V.S. 97.0 67 20 O2 sat 95% with O2 at 2 LPM via n/c.  view     2/4/2021 07:45 Nurses Note Note Text: Resident seen by Dr. for discharge. Orders pending at this time.  view     2/4/2021 07:36 Nurses Note Note Text: CRNP and Dr. updated on O2 sat 88% on RA with f/u of 93% with O2 on at 2 LPM as well as rest of VS, 3-11 shift 2/3/21. No n/o's at this time.  view     2/3/2021 21:17 Nurses Note Note Text: Resident Sp02 88% on RA. Pulse 124. Respirations 40. PRN morphine given and O2 applied via NC at 2L/min. After recheck pulse ox up to 93%, pulse 100, and respirations 22. Resident appears comfortable at this time.  view     2/3/2021 20:05 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective [linked]  view     2/3/2021 19:48 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN given for SOB after elevation of HOB not effective.  view     2/3/2021 11:51 Nurses Note Note Text: CRNP updated rapid COVID test done for d/c tomorrow was negative. No n/o's at this time.  view     2/3/2021 11:44 Nurses Note Note Text: Daughter notified of rapid covid swab being negative.  view     2/3/2021 09:50 Orders - Administration Note Note Text: Obtain Rapid Covid test on 2/3/2021 for discharge. Please give copy of results to Social Worker  every day shift for covid testing for 1 Day  Completed and negative.  view     2/3/2021 08:45 Skilled Nursing Note Reason for skilled service: Therapy  describe skilled service: Nursing, therapy  assessment: V.S. 97.8 79 18 138/84  Orientation: Oriented to self only.  Oxygen: O2 sat 94% on RA  Edema: Trace edema noted BLE. Pedal pulses present.  Pain: Denies pain or discomfort at this time.  Nursing note: Pt. alert and responsive. Skin warm and dry. Lung sounds diminished. No respiratory distress observed at this time. Abdomen soft. BS+ in all 4 quads. Continent/Incontinent of B&B. 1 assist with ambulation, transfers. 1 assist with ADL's. Working with therapy on gait training, therapeutic exercise, therapeutic activities & neuromuscular reeducation.  view     2/2/2021 14:37 Progress Note Note Text: Per health professional at Sr Living, prepared to accept patient to their Memory Care Unit 2/4. Transportation arranged for 11 AM per family request. Daughter (POA) updated on d/c time on 2/4/21. Facility requesting rapid COVID test completed prior to d/c and results sent to them. All other information sent for continuity of care."
	"1007310-1"	"1007310-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	"view     2/5/2021 09:23 e Progress Note Note Text: Patient passed away in the facility this morning.  view     2/5/2021 08:39 Orders - Administration Note Note Text: Resident passed.  view     2/5/2021 08:33 Nurses Note Note Text: Body released to funeral home at this time. Personal effects sent with resident include: 1 pair of glasses, 1 yellow wedding band, 1silver spoon ring, 1 ring with black and clear stones. Resident has own teeth  view     2/5/2021 08:32 Nurses Note Note Text: cause of death per CRNP failure to thrive.  view     2/5/2021 07:44 Orders - Administration Note Note Text: Take and document temp & PO2  every 4 hours for MONITORING  Resident passed.  view     2/5/2021 06:49 Nurses Note Note Text: Son returned call and was updated of resident's passing this am  view     2/5/2021 06:33 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Unknown  Resident expired @ 0604 [linked]  view     2/5/2021 06:06 Nurses Note Note Text: Res found without pulse or respirations. Pronounced at 0604. Updated. N/o's for RN to pronounce, release body to funeral home, dispose of medications per facility policy. Daughter updated. Funeral Home called to release body.  view     2/5/2021 05:26 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Pulse ox 60% on O2 @ 5L/min via mask. Resps 44 per minute.  view     2/5/2021 01:57 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/5/2021 00:52 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Residents resps are 40 per minute, pulse ox 76% on O2 @ 5L/min via mask. Resps are labored, shallow and rapid.  view     2/5/2021 00:48 Nurses Note Note Text: Nonresponsive to verbal and tactile stimulation. Appears comfortable.  view     2/4/2021 22:01 Nurses Note Note Text: Resident resting comfortably, breathing becoming increasingly shallow, wearing O2 via mask at 5L via mask, no dyspnea noted, feet are mottled, oral and peri care provided Q2H. No s/s of pain or discomfort.  view     2/4/2021 21:40 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective [linked]  view     2/4/2021 19:32 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  medicated for air hunger, RR 28 to 32/ min  view     2/4/2021 19:22 Nurses Note Note Text: Daughter updated on N/O to increase Morphine Sulfate 20mg/mL 0.25mL to Q2H prn from Q6H prn.  view     2/4/2021 18:06 Nurses Note Note Text: POA Daughter and daughter aware of residents current condition.  view     2/4/2021 11:58 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/4/2021 11:13 Nurses Note Note Text: Pt. noted to be lethargic at this time. Does respond to verbal and tactile stimuli by opening her eyes but non verbal currently. Skin warm and dry. No mottling or apnea observed at this time. O2 sat 88% with O2 at 2 LPM via n/c. On increased to 3 LPM via mask as pt. noted to be mouth breathing. Respirations 28. F/U O2 sat 93%. HOB elevated. Pt. medicated with morphine by LPN. Daughter updated on pt.'s condition. Does not want pt. sent out to hospital and would like comfort measures to continue. Daughter also in agreement with delay in d/c d/t pt.'s condition.CRNP updated on pt.'s condition, delay in d/c and daughter's wishes. No n/o's at this time.  view     2/4/2021 10:56 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  Resident showing s/s of discomfort. SOB at this time and high respirations. Repositioned, changed for incontinence care and mouth care provided.    view     2/4/2021 10:34  Progress Note Note Text: Spoke with RN regarding change in condition. Updated Sr Living regarding change. Recommendation to cancel d/c/transfer for today, see how resident does through the weekend and re-evaluate on Monday. Daughter updated on cancellation of d/c today.  view     2/4/2021 10:04 Nurses Note Note Text: Daughter aware that resident's O2 sat was 88% on room air on 3-11 shift and that oxygen was applied via nasal cannula.  view     2/4/2021 10:03 Nurses Note Note Text: N/O: Discharge 2/4/21 with scripts to Sr. Living. Daughter aware.  view     2/4/2021 09:53 Nurses Note Note Text: Pt. to be d/c'd to another facility this am as per MD order. Pt. alert and responsive. Skin assessment done as per facility policy. No pressure areas noted at this time. No s/sx of pain or discomfort observed at this time. V.S. 97.0 67 20 O2 sat 95% with O2 at 2 LPM via n/c.  view     2/4/2021 07:45 Nurses Note Note Text: Resident seen by Dr. for discharge. Orders pending at this time.  view     2/4/2021 07:36 Nurses Note Note Text: CRNP and Dr. updated on O2 sat 88% on RA with f/u of 93% with O2 on at 2 LPM as well as rest of VS, 3-11 shift 2/3/21. No n/o's at this time.  view     2/3/2021 21:17 Nurses Note Note Text: Resident Sp02 88% on RA. Pulse 124. Respirations 40. PRN morphine given and O2 applied via NC at 2L/min. After recheck pulse ox up to 93%, pulse 100, and respirations 22. Resident appears comfortable at this time.  view     2/3/2021 20:05 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective [linked]  view     2/3/2021 19:48 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN given for SOB after elevation of HOB not effective.  view     2/3/2021 11:51 Nurses Note Note Text: CRNP updated rapid COVID test done for d/c tomorrow was negative. No n/o's at this time.  view     2/3/2021 11:44 Nurses Note Note Text: Daughter notified of rapid covid swab being negative.  view     2/3/2021 09:50 Orders - Administration Note Note Text: Obtain Rapid Covid test on 2/3/2021 for discharge. Please give copy of results to Social Worker  every day shift for covid testing for 1 Day  Completed and negative.  view     2/3/2021 08:45 Skilled Nursing Note Reason for skilled service: Therapy  describe skilled service: Nursing, therapy  assessment: V.S. 97.8 79 18 138/84  Orientation: Oriented to self only.  Oxygen: O2 sat 94% on RA  Edema: Trace edema noted BLE. Pedal pulses present.  Pain: Denies pain or discomfort at this time.  Nursing note: Pt. alert and responsive. Skin warm and dry. Lung sounds diminished. No respiratory distress observed at this time. Abdomen soft. BS+ in all 4 quads. Continent/Incontinent of B&B. 1 assist with ambulation, transfers. 1 assist with ADL's. Working with therapy on gait training, therapeutic exercise, therapeutic activities & neuromuscular reeducation.  view     2/2/2021 14:37 Progress Note Note Text: Per health professional at Sr Living, prepared to accept patient to their Memory Care Unit 2/4. Transportation arranged for 11 AM per family request. Daughter (POA) updated on d/c time on 2/4/21. Facility requesting rapid COVID test completed prior to d/c and results sent to them. All other information sent for continuity of care."
	"1007310-1"	"1007310-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	"view     2/5/2021 09:23 e Progress Note Note Text: Patient passed away in the facility this morning.  view     2/5/2021 08:39 Orders - Administration Note Note Text: Resident passed.  view     2/5/2021 08:33 Nurses Note Note Text: Body released to funeral home at this time. Personal effects sent with resident include: 1 pair of glasses, 1 yellow wedding band, 1silver spoon ring, 1 ring with black and clear stones. Resident has own teeth  view     2/5/2021 08:32 Nurses Note Note Text: cause of death per CRNP failure to thrive.  view     2/5/2021 07:44 Orders - Administration Note Note Text: Take and document temp & PO2  every 4 hours for MONITORING  Resident passed.  view     2/5/2021 06:49 Nurses Note Note Text: Son returned call and was updated of resident's passing this am  view     2/5/2021 06:33 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Unknown  Resident expired @ 0604 [linked]  view     2/5/2021 06:06 Nurses Note Note Text: Res found without pulse or respirations. Pronounced at 0604. Updated. N/o's for RN to pronounce, release body to funeral home, dispose of medications per facility policy. Daughter updated. Funeral Home called to release body.  view     2/5/2021 05:26 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Pulse ox 60% on O2 @ 5L/min via mask. Resps 44 per minute.  view     2/5/2021 01:57 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/5/2021 00:52 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Residents resps are 40 per minute, pulse ox 76% on O2 @ 5L/min via mask. Resps are labored, shallow and rapid.  view     2/5/2021 00:48 Nurses Note Note Text: Nonresponsive to verbal and tactile stimulation. Appears comfortable.  view     2/4/2021 22:01 Nurses Note Note Text: Resident resting comfortably, breathing becoming increasingly shallow, wearing O2 via mask at 5L via mask, no dyspnea noted, feet are mottled, oral and peri care provided Q2H. No s/s of pain or discomfort.  view     2/4/2021 21:40 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective [linked]  view     2/4/2021 19:32 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  medicated for air hunger, RR 28 to 32/ min  view     2/4/2021 19:22 Nurses Note Note Text: Daughter updated on N/O to increase Morphine Sulfate 20mg/mL 0.25mL to Q2H prn from Q6H prn.  view     2/4/2021 18:06 Nurses Note Note Text: POA Daughter and daughter aware of residents current condition.  view     2/4/2021 11:58 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/4/2021 11:13 Nurses Note Note Text: Pt. noted to be lethargic at this time. Does respond to verbal and tactile stimuli by opening her eyes but non verbal currently. Skin warm and dry. No mottling or apnea observed at this time. O2 sat 88% with O2 at 2 LPM via n/c. On increased to 3 LPM via mask as pt. noted to be mouth breathing. Respirations 28. F/U O2 sat 93%. HOB elevated. Pt. medicated with morphine by LPN. Daughter updated on pt.'s condition. Does not want pt. sent out to hospital and would like comfort measures to continue. Daughter also in agreement with delay in d/c d/t pt.'s condition.CRNP updated on pt.'s condition, delay in d/c and daughter's wishes. No n/o's at this time.  view     2/4/2021 10:56 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  Resident showing s/s of discomfort. SOB at this time and high respirations. Repositioned, changed for incontinence care and mouth care provided.    view     2/4/2021 10:34  Progress Note Note Text: Spoke with RN regarding change in condition. Updated Sr Living regarding change. Recommendation to cancel d/c/transfer for today, see how resident does through the weekend and re-evaluate on Monday. Daughter updated on cancellation of d/c today.  view     2/4/2021 10:04 Nurses Note Note Text: Daughter aware that resident's O2 sat was 88% on room air on 3-11 shift and that oxygen was applied via nasal cannula.  view     2/4/2021 10:03 Nurses Note Note Text: N/O: Discharge 2/4/21 with scripts to Sr. Living. Daughter aware.  view     2/4/2021 09:53 Nurses Note Note Text: Pt. to be d/c'd to another facility this am as per MD order. Pt. alert and responsive. Skin assessment done as per facility policy. No pressure areas noted at this time. No s/sx of pain or discomfort observed at this time. V.S. 97.0 67 20 O2 sat 95% with O2 at 2 LPM via n/c.  view     2/4/2021 07:45 Nurses Note Note Text: Resident seen by Dr. for discharge. Orders pending at this time.  view     2/4/2021 07:36 Nurses Note Note Text: CRNP and Dr. updated on O2 sat 88% on RA with f/u of 93% with O2 on at 2 LPM as well as rest of VS, 3-11 shift 2/3/21. No n/o's at this time.  view     2/3/2021 21:17 Nurses Note Note Text: Resident Sp02 88% on RA. Pulse 124. Respirations 40. PRN morphine given and O2 applied via NC at 2L/min. After recheck pulse ox up to 93%, pulse 100, and respirations 22. Resident appears comfortable at this time.  view     2/3/2021 20:05 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective [linked]  view     2/3/2021 19:48 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN given for SOB after elevation of HOB not effective.  view     2/3/2021 11:51 Nurses Note Note Text: CRNP updated rapid COVID test done for d/c tomorrow was negative. No n/o's at this time.  view     2/3/2021 11:44 Nurses Note Note Text: Daughter notified of rapid covid swab being negative.  view     2/3/2021 09:50 Orders - Administration Note Note Text: Obtain Rapid Covid test on 2/3/2021 for discharge. Please give copy of results to Social Worker  every day shift for covid testing for 1 Day  Completed and negative.  view     2/3/2021 08:45 Skilled Nursing Note Reason for skilled service: Therapy  describe skilled service: Nursing, therapy  assessment: V.S. 97.8 79 18 138/84  Orientation: Oriented to self only.  Oxygen: O2 sat 94% on RA  Edema: Trace edema noted BLE. Pedal pulses present.  Pain: Denies pain or discomfort at this time.  Nursing note: Pt. alert and responsive. Skin warm and dry. Lung sounds diminished. No respiratory distress observed at this time. Abdomen soft. BS+ in all 4 quads. Continent/Incontinent of B&B. 1 assist with ambulation, transfers. 1 assist with ADL's. Working with therapy on gait training, therapeutic exercise, therapeutic activities & neuromuscular reeducation.  view     2/2/2021 14:37 Progress Note Note Text: Per health professional at Sr Living, prepared to accept patient to their Memory Care Unit 2/4. Transportation arranged for 11 AM per family request. Daughter (POA) updated on d/c time on 2/4/21. Facility requesting rapid COVID test completed prior to d/c and results sent to them. All other information sent for continuity of care."
	"1007310-1"	"1007310-1"	"SKIN WARM"	"10040952"	"65-79 years"	"65-79"	"view     2/5/2021 09:23 e Progress Note Note Text: Patient passed away in the facility this morning.  view     2/5/2021 08:39 Orders - Administration Note Note Text: Resident passed.  view     2/5/2021 08:33 Nurses Note Note Text: Body released to funeral home at this time. Personal effects sent with resident include: 1 pair of glasses, 1 yellow wedding band, 1silver spoon ring, 1 ring with black and clear stones. Resident has own teeth  view     2/5/2021 08:32 Nurses Note Note Text: cause of death per CRNP failure to thrive.  view     2/5/2021 07:44 Orders - Administration Note Note Text: Take and document temp & PO2  every 4 hours for MONITORING  Resident passed.  view     2/5/2021 06:49 Nurses Note Note Text: Son returned call and was updated of resident's passing this am  view     2/5/2021 06:33 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Unknown  Resident expired @ 0604 [linked]  view     2/5/2021 06:06 Nurses Note Note Text: Res found without pulse or respirations. Pronounced at 0604. Updated. N/o's for RN to pronounce, release body to funeral home, dispose of medications per facility policy. Daughter updated. Funeral Home called to release body.  view     2/5/2021 05:26 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Pulse ox 60% on O2 @ 5L/min via mask. Resps 44 per minute.  view     2/5/2021 01:57 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/5/2021 00:52 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Residents resps are 40 per minute, pulse ox 76% on O2 @ 5L/min via mask. Resps are labored, shallow and rapid.  view     2/5/2021 00:48 Nurses Note Note Text: Nonresponsive to verbal and tactile stimulation. Appears comfortable.  view     2/4/2021 22:01 Nurses Note Note Text: Resident resting comfortably, breathing becoming increasingly shallow, wearing O2 via mask at 5L via mask, no dyspnea noted, feet are mottled, oral and peri care provided Q2H. No s/s of pain or discomfort.  view     2/4/2021 21:40 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective [linked]  view     2/4/2021 19:32 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  medicated for air hunger, RR 28 to 32/ min  view     2/4/2021 19:22 Nurses Note Note Text: Daughter updated on N/O to increase Morphine Sulfate 20mg/mL 0.25mL to Q2H prn from Q6H prn.  view     2/4/2021 18:06 Nurses Note Note Text: POA Daughter and daughter aware of residents current condition.  view     2/4/2021 11:58 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/4/2021 11:13 Nurses Note Note Text: Pt. noted to be lethargic at this time. Does respond to verbal and tactile stimuli by opening her eyes but non verbal currently. Skin warm and dry. No mottling or apnea observed at this time. O2 sat 88% with O2 at 2 LPM via n/c. On increased to 3 LPM via mask as pt. noted to be mouth breathing. Respirations 28. F/U O2 sat 93%. HOB elevated. Pt. medicated with morphine by LPN. Daughter updated on pt.'s condition. Does not want pt. sent out to hospital and would like comfort measures to continue. Daughter also in agreement with delay in d/c d/t pt.'s condition.CRNP updated on pt.'s condition, delay in d/c and daughter's wishes. No n/o's at this time.  view     2/4/2021 10:56 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  Resident showing s/s of discomfort. SOB at this time and high respirations. Repositioned, changed for incontinence care and mouth care provided.    view     2/4/2021 10:34  Progress Note Note Text: Spoke with RN regarding change in condition. Updated Sr Living regarding change. Recommendation to cancel d/c/transfer for today, see how resident does through the weekend and re-evaluate on Monday. Daughter updated on cancellation of d/c today.  view     2/4/2021 10:04 Nurses Note Note Text: Daughter aware that resident's O2 sat was 88% on room air on 3-11 shift and that oxygen was applied via nasal cannula.  view     2/4/2021 10:03 Nurses Note Note Text: N/O: Discharge 2/4/21 with scripts to Sr. Living. Daughter aware.  view     2/4/2021 09:53 Nurses Note Note Text: Pt. to be d/c'd to another facility this am as per MD order. Pt. alert and responsive. Skin assessment done as per facility policy. No pressure areas noted at this time. No s/sx of pain or discomfort observed at this time. V.S. 97.0 67 20 O2 sat 95% with O2 at 2 LPM via n/c.  view     2/4/2021 07:45 Nurses Note Note Text: Resident seen by Dr. for discharge. Orders pending at this time.  view     2/4/2021 07:36 Nurses Note Note Text: CRNP and Dr. updated on O2 sat 88% on RA with f/u of 93% with O2 on at 2 LPM as well as rest of VS, 3-11 shift 2/3/21. No n/o's at this time.  view     2/3/2021 21:17 Nurses Note Note Text: Resident Sp02 88% on RA. Pulse 124. Respirations 40. PRN morphine given and O2 applied via NC at 2L/min. After recheck pulse ox up to 93%, pulse 100, and respirations 22. Resident appears comfortable at this time.  view     2/3/2021 20:05 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective [linked]  view     2/3/2021 19:48 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN given for SOB after elevation of HOB not effective.  view     2/3/2021 11:51 Nurses Note Note Text: CRNP updated rapid COVID test done for d/c tomorrow was negative. No n/o's at this time.  view     2/3/2021 11:44 Nurses Note Note Text: Daughter notified of rapid covid swab being negative.  view     2/3/2021 09:50 Orders - Administration Note Note Text: Obtain Rapid Covid test on 2/3/2021 for discharge. Please give copy of results to Social Worker  every day shift for covid testing for 1 Day  Completed and negative.  view     2/3/2021 08:45 Skilled Nursing Note Reason for skilled service: Therapy  describe skilled service: Nursing, therapy  assessment: V.S. 97.8 79 18 138/84  Orientation: Oriented to self only.  Oxygen: O2 sat 94% on RA  Edema: Trace edema noted BLE. Pedal pulses present.  Pain: Denies pain or discomfort at this time.  Nursing note: Pt. alert and responsive. Skin warm and dry. Lung sounds diminished. No respiratory distress observed at this time. Abdomen soft. BS+ in all 4 quads. Continent/Incontinent of B&B. 1 assist with ambulation, transfers. 1 assist with ADL's. Working with therapy on gait training, therapeutic exercise, therapeutic activities & neuromuscular reeducation.  view     2/2/2021 14:37 Progress Note Note Text: Per health professional at Sr Living, prepared to accept patient to their Memory Care Unit 2/4. Transportation arranged for 11 AM per family request. Daughter (POA) updated on d/c time on 2/4/21. Facility requesting rapid COVID test completed prior to d/c and results sent to them. All other information sent for continuity of care."
	"1007310-1"	"1007310-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"view     2/5/2021 09:23 e Progress Note Note Text: Patient passed away in the facility this morning.  view     2/5/2021 08:39 Orders - Administration Note Note Text: Resident passed.  view     2/5/2021 08:33 Nurses Note Note Text: Body released to funeral home at this time. Personal effects sent with resident include: 1 pair of glasses, 1 yellow wedding band, 1silver spoon ring, 1 ring with black and clear stones. Resident has own teeth  view     2/5/2021 08:32 Nurses Note Note Text: cause of death per CRNP failure to thrive.  view     2/5/2021 07:44 Orders - Administration Note Note Text: Take and document temp & PO2  every 4 hours for MONITORING  Resident passed.  view     2/5/2021 06:49 Nurses Note Note Text: Son returned call and was updated of resident's passing this am  view     2/5/2021 06:33 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Unknown  Resident expired @ 0604 [linked]  view     2/5/2021 06:06 Nurses Note Note Text: Res found without pulse or respirations. Pronounced at 0604. Updated. N/o's for RN to pronounce, release body to funeral home, dispose of medications per facility policy. Daughter updated. Funeral Home called to release body.  view     2/5/2021 05:26 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Pulse ox 60% on O2 @ 5L/min via mask. Resps 44 per minute.  view     2/5/2021 01:57 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/5/2021 00:52 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  Residents resps are 40 per minute, pulse ox 76% on O2 @ 5L/min via mask. Resps are labored, shallow and rapid.  view     2/5/2021 00:48 Nurses Note Note Text: Nonresponsive to verbal and tactile stimulation. Appears comfortable.  view     2/4/2021 22:01 Nurses Note Note Text: Resident resting comfortably, breathing becoming increasingly shallow, wearing O2 via mask at 5L via mask, no dyspnea noted, feet are mottled, oral and peri care provided Q2H. No s/s of pain or discomfort.  view     2/4/2021 21:40 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  PRN Administration was: Effective [linked]  view     2/4/2021 19:32 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger  medicated for air hunger, RR 28 to 32/ min  view     2/4/2021 19:22 Nurses Note Note Text: Daughter updated on N/O to increase Morphine Sulfate 20mg/mL 0.25mL to Q2H prn from Q6H prn.  view     2/4/2021 18:06 Nurses Note Note Text: POA Daughter and daughter aware of residents current condition.  view     2/4/2021 11:58 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective  Follow-up Pain Scale was: 2 [linked]  view     2/4/2021 11:13 Nurses Note Note Text: Pt. noted to be lethargic at this time. Does respond to verbal and tactile stimuli by opening her eyes but non verbal currently. Skin warm and dry. No mottling or apnea observed at this time. O2 sat 88% with O2 at 2 LPM via n/c. On increased to 3 LPM via mask as pt. noted to be mouth breathing. Respirations 28. F/U O2 sat 93%. HOB elevated. Pt. medicated with morphine by LPN. Daughter updated on pt.'s condition. Does not want pt. sent out to hospital and would like comfort measures to continue. Daughter also in agreement with delay in d/c d/t pt.'s condition.CRNP updated on pt.'s condition, delay in d/c and daughter's wishes. No n/o's at this time.  view     2/4/2021 10:56 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  Resident showing s/s of discomfort. SOB at this time and high respirations. Repositioned, changed for incontinence care and mouth care provided.    view     2/4/2021 10:34  Progress Note Note Text: Spoke with RN regarding change in condition. Updated Sr Living regarding change. Recommendation to cancel d/c/transfer for today, see how resident does through the weekend and re-evaluate on Monday. Daughter updated on cancellation of d/c today.  view     2/4/2021 10:04 Nurses Note Note Text: Daughter aware that resident's O2 sat was 88% on room air on 3-11 shift and that oxygen was applied via nasal cannula.  view     2/4/2021 10:03 Nurses Note Note Text: N/O: Discharge 2/4/21 with scripts to Sr. Living. Daughter aware.  view     2/4/2021 09:53 Nurses Note Note Text: Pt. to be d/c'd to another facility this am as per MD order. Pt. alert and responsive. Skin assessment done as per facility policy. No pressure areas noted at this time. No s/sx of pain or discomfort observed at this time. V.S. 97.0 67 20 O2 sat 95% with O2 at 2 LPM via n/c.  view     2/4/2021 07:45 Nurses Note Note Text: Resident seen by Dr. for discharge. Orders pending at this time.  view     2/4/2021 07:36 Nurses Note Note Text: CRNP and Dr. updated on O2 sat 88% on RA with f/u of 93% with O2 on at 2 LPM as well as rest of VS, 3-11 shift 2/3/21. No n/o's at this time.  view     2/3/2021 21:17 Nurses Note Note Text: Resident Sp02 88% on RA. Pulse 124. Respirations 40. PRN morphine given and O2 applied via NC at 2L/min. After recheck pulse ox up to 93%, pulse 100, and respirations 22. Resident appears comfortable at this time.  view     2/3/2021 20:05 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN Administration was: Effective [linked]  view     2/3/2021 19:48 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML  Give 0.25 ml by mouth every 6 hours as needed for pain/SOB  PRN given for SOB after elevation of HOB not effective.  view     2/3/2021 11:51 Nurses Note Note Text: CRNP updated rapid COVID test done for d/c tomorrow was negative. No n/o's at this time.  view     2/3/2021 11:44 Nurses Note Note Text: Daughter notified of rapid covid swab being negative.  view     2/3/2021 09:50 Orders - Administration Note Note Text: Obtain Rapid Covid test on 2/3/2021 for discharge. Please give copy of results to Social Worker  every day shift for covid testing for 1 Day  Completed and negative.  view     2/3/2021 08:45 Skilled Nursing Note Reason for skilled service: Therapy  describe skilled service: Nursing, therapy  assessment: V.S. 97.8 79 18 138/84  Orientation: Oriented to self only.  Oxygen: O2 sat 94% on RA  Edema: Trace edema noted BLE. Pedal pulses present.  Pain: Denies pain or discomfort at this time.  Nursing note: Pt. alert and responsive. Skin warm and dry. Lung sounds diminished. No respiratory distress observed at this time. Abdomen soft. BS+ in all 4 quads. Continent/Incontinent of B&B. 1 assist with ambulation, transfers. 1 assist with ADL's. Working with therapy on gait training, therapeutic exercise, therapeutic activities & neuromuscular reeducation.  view     2/2/2021 14:37 Progress Note Note Text: Per health professional at Sr Living, prepared to accept patient to their Memory Care Unit 2/4. Transportation arranged for 11 AM per family request. Daughter (POA) updated on d/c time on 2/4/21. Facility requesting rapid COVID test completed prior to d/c and results sent to them. All other information sent for continuity of care."
	"1027141-1"	"1027141-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"The patient reported feeling well.  I discussed with him the Covid-19 vaccine and he was able to state that he wanted it and to sign his consent form.  The facility reported they had discussed this with him and he had agreed prior to my visit."
	"1027757-1"	"1027757-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death"
	"1030586-1"	"1030586-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"This individual's employer informed our facility that he passed away at his home on 2/14/2021. Since he was not brought into our hospital, we do not have information regarding other health conditions or active medications. Since this individual received his second covid vaccine three days prior, this was reported to Moderna in addition to this VAERS report being completed. The coroner for County can be contacted."
	"1036678-1"	"1036678-1"	"CARDIAC FAILURE"	"10007554"	"65-79 years"	"65-79"	"Resident did not exhibit any side effects from the vaccine.  Staff spoke with him in his room at approximately 7:20am and returned to his room  just a few minutes later and he was unresponsive.  When the RN got to the room he had CTB.  Physician  documented heart failure and end stage kidney disease on the death certificate."
	"1036678-1"	"1036678-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Resident did not exhibit any side effects from the vaccine.  Staff spoke with him in his room at approximately 7:20am and returned to his room  just a few minutes later and he was unresponsive.  When the RN got to the room he had CTB.  Physician  documented heart failure and end stage kidney disease on the death certificate."
	"1036678-1"	"1036678-1"	"END STAGE RENAL DISEASE"	"10077512"	"65-79 years"	"65-79"	"Resident did not exhibit any side effects from the vaccine.  Staff spoke with him in his room at approximately 7:20am and returned to his room  just a few minutes later and he was unresponsive.  When the RN got to the room he had CTB.  Physician  documented heart failure and end stage kidney disease on the death certificate."
	"1036678-1"	"1036678-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"Resident did not exhibit any side effects from the vaccine.  Staff spoke with him in his room at approximately 7:20am and returned to his room  just a few minutes later and he was unresponsive.  When the RN got to the room he had CTB.  Physician  documented heart failure and end stage kidney disease on the death certificate."
	"1038527-1"	"1038527-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Per EMS/Hospital report patient had difficulty breathing and cardiac arrest with prolonged CPR (greater than 45 mins in the ER) who was resuscitated.  Family subsequently arrived including son and daughter and all family members were in the ER room are in agreement that patient would not want further aggressive cares given her extremely poor prognosis in light of chronic debilitation with numerous medical issues and now a very long period of CPR.   Hospital Course After updating family they stated patient would not want further aggressive cares given her grim prognosis and chronic severe and debilitating medical issues.  She continued to have myoclonic jerking.  She was extubated to comfort cares in the ER and did not pass immediately therefore brought to a room.  She received comfort cares and passed away at 0450 with family present."
	"1038527-1"	"1038527-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Per EMS/Hospital report patient had difficulty breathing and cardiac arrest with prolonged CPR (greater than 45 mins in the ER) who was resuscitated.  Family subsequently arrived including son and daughter and all family members were in the ER room are in agreement that patient would not want further aggressive cares given her extremely poor prognosis in light of chronic debilitation with numerous medical issues and now a very long period of CPR.   Hospital Course After updating family they stated patient would not want further aggressive cares given her grim prognosis and chronic severe and debilitating medical issues.  She continued to have myoclonic jerking.  She was extubated to comfort cares in the ER and did not pass immediately therefore brought to a room.  She received comfort cares and passed away at 0450 with family present."
	"1038527-1"	"1038527-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Per EMS/Hospital report patient had difficulty breathing and cardiac arrest with prolonged CPR (greater than 45 mins in the ER) who was resuscitated.  Family subsequently arrived including son and daughter and all family members were in the ER room are in agreement that patient would not want further aggressive cares given her extremely poor prognosis in light of chronic debilitation with numerous medical issues and now a very long period of CPR.   Hospital Course After updating family they stated patient would not want further aggressive cares given her grim prognosis and chronic severe and debilitating medical issues.  She continued to have myoclonic jerking.  She was extubated to comfort cares in the ER and did not pass immediately therefore brought to a room.  She received comfort cares and passed away at 0450 with family present."
	"1038527-1"	"1038527-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Per EMS/Hospital report patient had difficulty breathing and cardiac arrest with prolonged CPR (greater than 45 mins in the ER) who was resuscitated.  Family subsequently arrived including son and daughter and all family members were in the ER room are in agreement that patient would not want further aggressive cares given her extremely poor prognosis in light of chronic debilitation with numerous medical issues and now a very long period of CPR.   Hospital Course After updating family they stated patient would not want further aggressive cares given her grim prognosis and chronic severe and debilitating medical issues.  She continued to have myoclonic jerking.  She was extubated to comfort cares in the ER and did not pass immediately therefore brought to a room.  She received comfort cares and passed away at 0450 with family present."
	"1038527-1"	"1038527-1"	"MYOCLONUS"	"10028622"	"65-79 years"	"65-79"	"Per EMS/Hospital report patient had difficulty breathing and cardiac arrest with prolonged CPR (greater than 45 mins in the ER) who was resuscitated.  Family subsequently arrived including son and daughter and all family members were in the ER room are in agreement that patient would not want further aggressive cares given her extremely poor prognosis in light of chronic debilitation with numerous medical issues and now a very long period of CPR.   Hospital Course After updating family they stated patient would not want further aggressive cares given her grim prognosis and chronic severe and debilitating medical issues.  She continued to have myoclonic jerking.  She was extubated to comfort cares in the ER and did not pass immediately therefore brought to a room.  She received comfort cares and passed away at 0450 with family present."
	"1038527-1"	"1038527-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Per EMS/Hospital report patient had difficulty breathing and cardiac arrest with prolonged CPR (greater than 45 mins in the ER) who was resuscitated.  Family subsequently arrived including son and daughter and all family members were in the ER room are in agreement that patient would not want further aggressive cares given her extremely poor prognosis in light of chronic debilitation with numerous medical issues and now a very long period of CPR.   Hospital Course After updating family they stated patient would not want further aggressive cares given her grim prognosis and chronic severe and debilitating medical issues.  She continued to have myoclonic jerking.  She was extubated to comfort cares in the ER and did not pass immediately therefore brought to a room.  She received comfort cares and passed away at 0450 with family present."
	"1041230-1"	"1041230-1"	"ACUTE MYOCARDIAL INFARCTION"	"10000891"	"65-79 years"	"65-79"	"Patient received first dose of covid vaccine on 1/22/2021.  Patient had no immediate reaction.  Patient presented  to the Emergency Department on 1/26/2021 c/o shortness of breath and chest pain. ECG showed a ST elevation myocardial infarction.  Patient was treated and transferred to a cath lab where he died.  Patient had significant coronary artery disease."
	"1041230-1"	"1041230-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	"Patient received first dose of covid vaccine on 1/22/2021.  Patient had no immediate reaction.  Patient presented  to the Emergency Department on 1/26/2021 c/o shortness of breath and chest pain. ECG showed a ST elevation myocardial infarction.  Patient was treated and transferred to a cath lab where he died.  Patient had significant coronary artery disease."
	"1041230-1"	"1041230-1"	"CORONARY ARTERY DISEASE"	"10011078"	"65-79 years"	"65-79"	"Patient received first dose of covid vaccine on 1/22/2021.  Patient had no immediate reaction.  Patient presented  to the Emergency Department on 1/26/2021 c/o shortness of breath and chest pain. ECG showed a ST elevation myocardial infarction.  Patient was treated and transferred to a cath lab where he died.  Patient had significant coronary artery disease."
	"1041230-1"	"1041230-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received first dose of covid vaccine on 1/22/2021.  Patient had no immediate reaction.  Patient presented  to the Emergency Department on 1/26/2021 c/o shortness of breath and chest pain. ECG showed a ST elevation myocardial infarction.  Patient was treated and transferred to a cath lab where he died.  Patient had significant coronary artery disease."
	"1041230-1"	"1041230-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient received first dose of covid vaccine on 1/22/2021.  Patient had no immediate reaction.  Patient presented  to the Emergency Department on 1/26/2021 c/o shortness of breath and chest pain. ECG showed a ST elevation myocardial infarction.  Patient was treated and transferred to a cath lab where he died.  Patient had significant coronary artery disease."
	"1041230-1"	"1041230-1"	"ELECTROCARDIOGRAM ST SEGMENT ELEVATION"	"10014392"	"65-79 years"	"65-79"	"Patient received first dose of covid vaccine on 1/22/2021.  Patient had no immediate reaction.  Patient presented  to the Emergency Department on 1/26/2021 c/o shortness of breath and chest pain. ECG showed a ST elevation myocardial infarction.  Patient was treated and transferred to a cath lab where he died.  Patient had significant coronary artery disease."
	"1051263-1"	"1051263-1"	"BRAIN HYPOXIA"	"10006127"	"65-79 years"	"65-79"	"Passed away; Found unconscious; Coma; Lack of oxygen to the brain; A spontaneous report was received from a consumer, concerning his mother, a 71-year-old female patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and passed away, prior to death, patient experienced lack of oxygen to the brain and was found unconscious and went to coma.  The patient's medical history reported included seizures. Concomitant medications included phenobarbital, lamotrigine and levetiracetam.   On 27 Jan 2021, approximately six days prior to the onset of events, the patient received their first of two planned doses of mRNA-1273 (lot number: 030L20A) intramuscularly for prophylaxis of COVID-19 infection.  On 01 Feb 2021 at 4 am, the patient was found to be unconscious on the couch, hence she was rushed to the hospital with lack of oxygen to the brain. Later, she went into a coma, hence she was in hospital for 30 hours and then was transferred to a different hospital for a second opinion on 06-Feb-2021, where she was passed away at 02:20 PM. Treatment information was not provided  Action taken with mRNA-1273 in response to the events were not applicable.  The outcome of events, lack of oxygen to the brain, found unconscious and coma were considered unknown.  The outcome of event passed away was fatal as she died on 06 Feb 2021 at 2:20 pm.  The cause of death was not provided.  Plans for an autopsy were unknown.; Reporter's Comments: This is a case of 71-year-old female subject with a history of seizures who died 6 days after receiving first dose of vaccine. Very limited information has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Passed away"
	"1051263-1"	"1051263-1"	"COMA"	"10010071"	"65-79 years"	"65-79"	"Passed away; Found unconscious; Coma; Lack of oxygen to the brain; A spontaneous report was received from a consumer, concerning his mother, a 71-year-old female patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and passed away, prior to death, patient experienced lack of oxygen to the brain and was found unconscious and went to coma.  The patient's medical history reported included seizures. Concomitant medications included phenobarbital, lamotrigine and levetiracetam.   On 27 Jan 2021, approximately six days prior to the onset of events, the patient received their first of two planned doses of mRNA-1273 (lot number: 030L20A) intramuscularly for prophylaxis of COVID-19 infection.  On 01 Feb 2021 at 4 am, the patient was found to be unconscious on the couch, hence she was rushed to the hospital with lack of oxygen to the brain. Later, she went into a coma, hence she was in hospital for 30 hours and then was transferred to a different hospital for a second opinion on 06-Feb-2021, where she was passed away at 02:20 PM. Treatment information was not provided  Action taken with mRNA-1273 in response to the events were not applicable.  The outcome of events, lack of oxygen to the brain, found unconscious and coma were considered unknown.  The outcome of event passed away was fatal as she died on 06 Feb 2021 at 2:20 pm.  The cause of death was not provided.  Plans for an autopsy were unknown.; Reporter's Comments: This is a case of 71-year-old female subject with a history of seizures who died 6 days after receiving first dose of vaccine. Very limited information has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Passed away"
	"1051263-1"	"1051263-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Passed away; Found unconscious; Coma; Lack of oxygen to the brain; A spontaneous report was received from a consumer, concerning his mother, a 71-year-old female patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and passed away, prior to death, patient experienced lack of oxygen to the brain and was found unconscious and went to coma.  The patient's medical history reported included seizures. Concomitant medications included phenobarbital, lamotrigine and levetiracetam.   On 27 Jan 2021, approximately six days prior to the onset of events, the patient received their first of two planned doses of mRNA-1273 (lot number: 030L20A) intramuscularly for prophylaxis of COVID-19 infection.  On 01 Feb 2021 at 4 am, the patient was found to be unconscious on the couch, hence she was rushed to the hospital with lack of oxygen to the brain. Later, she went into a coma, hence she was in hospital for 30 hours and then was transferred to a different hospital for a second opinion on 06-Feb-2021, where she was passed away at 02:20 PM. Treatment information was not provided  Action taken with mRNA-1273 in response to the events were not applicable.  The outcome of events, lack of oxygen to the brain, found unconscious and coma were considered unknown.  The outcome of event passed away was fatal as she died on 06 Feb 2021 at 2:20 pm.  The cause of death was not provided.  Plans for an autopsy were unknown.; Reporter's Comments: This is a case of 71-year-old female subject with a history of seizures who died 6 days after receiving first dose of vaccine. Very limited information has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Passed away"
	"1051263-1"	"1051263-1"	"LOSS OF CONSCIOUSNESS"	"10024855"	"65-79 years"	"65-79"	"Passed away; Found unconscious; Coma; Lack of oxygen to the brain; A spontaneous report was received from a consumer, concerning his mother, a 71-year-old female patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and passed away, prior to death, patient experienced lack of oxygen to the brain and was found unconscious and went to coma.  The patient's medical history reported included seizures. Concomitant medications included phenobarbital, lamotrigine and levetiracetam.   On 27 Jan 2021, approximately six days prior to the onset of events, the patient received their first of two planned doses of mRNA-1273 (lot number: 030L20A) intramuscularly for prophylaxis of COVID-19 infection.  On 01 Feb 2021 at 4 am, the patient was found to be unconscious on the couch, hence she was rushed to the hospital with lack of oxygen to the brain. Later, she went into a coma, hence she was in hospital for 30 hours and then was transferred to a different hospital for a second opinion on 06-Feb-2021, where she was passed away at 02:20 PM. Treatment information was not provided  Action taken with mRNA-1273 in response to the events were not applicable.  The outcome of events, lack of oxygen to the brain, found unconscious and coma were considered unknown.  The outcome of event passed away was fatal as she died on 06 Feb 2021 at 2:20 pm.  The cause of death was not provided.  Plans for an autopsy were unknown.; Reporter's Comments: This is a case of 71-year-old female subject with a history of seizures who died 6 days after receiving first dose of vaccine. Very limited information has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Passed away"
	"1052164-1"	"1052164-1"	"ABDOMINAL PAIN"	"10000081"	"65-79 years"	"65-79"	"911 called to patients house for trouble breathing and abdominal pain. Patient coded, wife presented DNR paperwork. Patient presented to Hospital DOA at 0958."
	"1052164-1"	"1052164-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"65-79 years"	"65-79"	"911 called to patients house for trouble breathing and abdominal pain. Patient coded, wife presented DNR paperwork. Patient presented to Hospital DOA at 0958."
	"1052164-1"	"1052164-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"911 called to patients house for trouble breathing and abdominal pain. Patient coded, wife presented DNR paperwork. Patient presented to Hospital DOA at 0958."
	"1052164-1"	"1052164-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"911 called to patients house for trouble breathing and abdominal pain. Patient coded, wife presented DNR paperwork. Patient presented to Hospital DOA at 0958."
	"1055418-1"	"1055418-1"	"CEREBROVASCULAR ACCIDENT"	"10008190"	"65-79 years"	"65-79"	"Patient suffered a stroke and passed away"
	"1055418-1"	"1055418-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient suffered a stroke and passed away"
	"1057997-1"	"1057997-1"	"AUTOPSY"	"10050117"	"65-79 years"	"65-79"	""""Feeling Hot"" without fever and nausea 10 hours post vaccine and resolved within 1 hour. Seizure, Hypotension, Unresponsive followed shortly by cardiac arrest and pulseless electrical activity 21 hours post vaccine. Pronounced dead 22 hours post vaccine""
	"1057997-1"	"1057997-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	""""Feeling Hot"" without fever and nausea 10 hours post vaccine and resolved within 1 hour. Seizure, Hypotension, Unresponsive followed shortly by cardiac arrest and pulseless electrical activity 21 hours post vaccine. Pronounced dead 22 hours post vaccine""
	"1057997-1"	"1057997-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	""""Feeling Hot"" without fever and nausea 10 hours post vaccine and resolved within 1 hour. Seizure, Hypotension, Unresponsive followed shortly by cardiac arrest and pulseless electrical activity 21 hours post vaccine. Pronounced dead 22 hours post vaccine""
	"1057997-1"	"1057997-1"	"FEELING HOT"	"10016334"	"65-79 years"	"65-79"	""""Feeling Hot"" without fever and nausea 10 hours post vaccine and resolved within 1 hour. Seizure, Hypotension, Unresponsive followed shortly by cardiac arrest and pulseless electrical activity 21 hours post vaccine. Pronounced dead 22 hours post vaccine""
	"1057997-1"	"1057997-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	""""Feeling Hot"" without fever and nausea 10 hours post vaccine and resolved within 1 hour. Seizure, Hypotension, Unresponsive followed shortly by cardiac arrest and pulseless electrical activity 21 hours post vaccine. Pronounced dead 22 hours post vaccine""
	"1057997-1"	"1057997-1"	"PULSELESS ELECTRICAL ACTIVITY"	"10058151"	"65-79 years"	"65-79"	""""Feeling Hot"" without fever and nausea 10 hours post vaccine and resolved within 1 hour. Seizure, Hypotension, Unresponsive followed shortly by cardiac arrest and pulseless electrical activity 21 hours post vaccine. Pronounced dead 22 hours post vaccine""
	"1057997-1"	"1057997-1"	"SARS-COV-2 TEST"	"10084354"	"65-79 years"	"65-79"	""""Feeling Hot"" without fever and nausea 10 hours post vaccine and resolved within 1 hour. Seizure, Hypotension, Unresponsive followed shortly by cardiac arrest and pulseless electrical activity 21 hours post vaccine. Pronounced dead 22 hours post vaccine""
	"1057997-1"	"1057997-1"	"SEIZURE"	"10039906"	"65-79 years"	"65-79"	""""Feeling Hot"" without fever and nausea 10 hours post vaccine and resolved within 1 hour. Seizure, Hypotension, Unresponsive followed shortly by cardiac arrest and pulseless electrical activity 21 hours post vaccine. Pronounced dead 22 hours post vaccine""
	"1057997-1"	"1057997-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	""""Feeling Hot"" without fever and nausea 10 hours post vaccine and resolved within 1 hour. Seizure, Hypotension, Unresponsive followed shortly by cardiac arrest and pulseless electrical activity 21 hours post vaccine. Pronounced dead 22 hours post vaccine""
	"1066126-1"	"1066126-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"death"
	"1066332-1"	"1066332-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"death"
	"1068700-1"	"1068700-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away 24 hours after receipt of 1st Dose Pfizer vaccine.  Provider does not feel death was due to vaccination. but underlying conditions. No immediate side effects noted from vaccination."
	"1069876-1"	"1069876-1"	"AGITATION"	"10001497"	"65-79 years"	"65-79"	"Vaccinated 2/20. At that time, had symptoms of incarcerated hernia, went to ED for evaluation. Not felt to warrant hospital admission. Returned two days later with agitation, altered mental status, and incarceration. Went to OR, uncomplicated hernia repair. Postoperatively, did not recover mental status. Went into arrythmias POD 4, hypotension ensued, had multiple interventions and evaluations without satisfying answers for clinical course."
	"1069876-1"	"1069876-1"	"ARRHYTHMIA"	"10003119"	"65-79 years"	"65-79"	"Vaccinated 2/20. At that time, had symptoms of incarcerated hernia, went to ED for evaluation. Not felt to warrant hospital admission. Returned two days later with agitation, altered mental status, and incarceration. Went to OR, uncomplicated hernia repair. Postoperatively, did not recover mental status. Went into arrythmias POD 4, hypotension ensued, had multiple interventions and evaluations without satisfying answers for clinical course."
	"1069876-1"	"1069876-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Vaccinated 2/20. At that time, had symptoms of incarcerated hernia, went to ED for evaluation. Not felt to warrant hospital admission. Returned two days later with agitation, altered mental status, and incarceration. Went to OR, uncomplicated hernia repair. Postoperatively, did not recover mental status. Went into arrythmias POD 4, hypotension ensued, had multiple interventions and evaluations without satisfying answers for clinical course."
	"1069876-1"	"1069876-1"	"HERNIA REPAIR"	"10062003"	"65-79 years"	"65-79"	"Vaccinated 2/20. At that time, had symptoms of incarcerated hernia, went to ED for evaluation. Not felt to warrant hospital admission. Returned two days later with agitation, altered mental status, and incarceration. Went to OR, uncomplicated hernia repair. Postoperatively, did not recover mental status. Went into arrythmias POD 4, hypotension ensued, had multiple interventions and evaluations without satisfying answers for clinical course."
	"1069876-1"	"1069876-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	"Vaccinated 2/20. At that time, had symptoms of incarcerated hernia, went to ED for evaluation. Not felt to warrant hospital admission. Returned two days later with agitation, altered mental status, and incarceration. Went to OR, uncomplicated hernia repair. Postoperatively, did not recover mental status. Went into arrythmias POD 4, hypotension ensued, had multiple interventions and evaluations without satisfying answers for clinical course."
	"1069876-1"	"1069876-1"	"INCARCERATED HERNIA"	"10021610"	"65-79 years"	"65-79"	"Vaccinated 2/20. At that time, had symptoms of incarcerated hernia, went to ED for evaluation. Not felt to warrant hospital admission. Returned two days later with agitation, altered mental status, and incarceration. Went to OR, uncomplicated hernia repair. Postoperatively, did not recover mental status. Went into arrythmias POD 4, hypotension ensued, had multiple interventions and evaluations without satisfying answers for clinical course."
	"1069876-1"	"1069876-1"	"MENTAL STATUS CHANGES"	"10048294"	"65-79 years"	"65-79"	"Vaccinated 2/20. At that time, had symptoms of incarcerated hernia, went to ED for evaluation. Not felt to warrant hospital admission. Returned two days later with agitation, altered mental status, and incarceration. Went to OR, uncomplicated hernia repair. Postoperatively, did not recover mental status. Went into arrythmias POD 4, hypotension ensued, had multiple interventions and evaluations without satisfying answers for clinical course."
	"1069876-1"	"1069876-1"	"SINUS ARRHYTHMIA"	"10040739"	"65-79 years"	"65-79"	"Vaccinated 2/20. At that time, had symptoms of incarcerated hernia, went to ED for evaluation. Not felt to warrant hospital admission. Returned two days later with agitation, altered mental status, and incarceration. Went to OR, uncomplicated hernia repair. Postoperatively, did not recover mental status. Went into arrythmias POD 4, hypotension ensued, had multiple interventions and evaluations without satisfying answers for clinical course."
	"1074753-1"	"1074753-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Pt. had a cardiac arrest and expired on 2/20/21."
	"1074753-1"	"1074753-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt. had a cardiac arrest and expired on 2/20/21."
	"1076158-1"	"1076158-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient was found dead at his home on 2/25/2021. He was last seen at home by his sister at 8:30pm on 2/24/21."
	"1077021-1"	"1077021-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away three days after receiving the vaccine."
	"1088338-1"	"1088338-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Case received vaccines 12/23/2020, and 01/13/2021. Public Health received notification that patient died 3/5/2021.  Not really sure if her death is related to vaccine administration but I was instructed to fill out this form."
	"1088815-1"	"1088815-1"	"ARTERIAL CATHETERISATION"	"10003148"	"65-79 years"	"65-79"	"PER MEDICAL RECORDS PATIENT PRESENTED TO ER VIA EMS REPORTING INTERMITTENT CHEST PAIN, FEELING LIKE HIS HEART WAS STOPPING."
	"1088815-1"	"1088815-1"	"CARDIAC PACEMAKER INSERTION"	"10007598"	"65-79 years"	"65-79"	"PER MEDICAL RECORDS PATIENT PRESENTED TO ER VIA EMS REPORTING INTERMITTENT CHEST PAIN, FEELING LIKE HIS HEART WAS STOPPING."
	"1088815-1"	"1088815-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"65-79 years"	"65-79"	"PER MEDICAL RECORDS PATIENT PRESENTED TO ER VIA EMS REPORTING INTERMITTENT CHEST PAIN, FEELING LIKE HIS HEART WAS STOPPING."
	"1088815-1"	"1088815-1"	"CENTRAL VENOUS CATHETERISATION"	"10053377"	"65-79 years"	"65-79"	"PER MEDICAL RECORDS PATIENT PRESENTED TO ER VIA EMS REPORTING INTERMITTENT CHEST PAIN, FEELING LIKE HIS HEART WAS STOPPING."
	"1088815-1"	"1088815-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	"PER MEDICAL RECORDS PATIENT PRESENTED TO ER VIA EMS REPORTING INTERMITTENT CHEST PAIN, FEELING LIKE HIS HEART WAS STOPPING."
	"1088815-1"	"1088815-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"PER MEDICAL RECORDS PATIENT PRESENTED TO ER VIA EMS REPORTING INTERMITTENT CHEST PAIN, FEELING LIKE HIS HEART WAS STOPPING."
	"1088815-1"	"1088815-1"	"ELECTROCARDIOGRAM"	"10014362"	"65-79 years"	"65-79"	"PER MEDICAL RECORDS PATIENT PRESENTED TO ER VIA EMS REPORTING INTERMITTENT CHEST PAIN, FEELING LIKE HIS HEART WAS STOPPING."
	"1088815-1"	"1088815-1"	"TROPONIN INCREASED"	"10058267"	"65-79 years"	"65-79"	"PER MEDICAL RECORDS PATIENT PRESENTED TO ER VIA EMS REPORTING INTERMITTENT CHEST PAIN, FEELING LIKE HIS HEART WAS STOPPING."
	"1090464-1"	"1090464-1"	"AGEUSIA"	"10001480"	"65-79 years"	"65-79"	"Feb. 10:  Moderna Vaccination #1 Administered (arm) Feb. 11-Feb. 19:  Developed a cough which worsened, weakness, confusion, could not follow instruction, fell, no appetite, fever of 102.8 on Feb. 19, no taste Feb. 20: Emergency Room with diagnosis of Covid pneumonia.  Given usual Covid treatment.  Became very confused, combatative, etc. Feb. 21:  Placed on ventilator Mar. 1:  Ventilator removed.  Patient expired."
	"1090464-1"	"1090464-1"	"AGGRESSION"	"10001488"	"65-79 years"	"65-79"	"Feb. 10:  Moderna Vaccination #1 Administered (arm) Feb. 11-Feb. 19:  Developed a cough which worsened, weakness, confusion, could not follow instruction, fell, no appetite, fever of 102.8 on Feb. 19, no taste Feb. 20: Emergency Room with diagnosis of Covid pneumonia.  Given usual Covid treatment.  Became very confused, combatative, etc. Feb. 21:  Placed on ventilator Mar. 1:  Ventilator removed.  Patient expired."
	"1090464-1"	"1090464-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Feb. 10:  Moderna Vaccination #1 Administered (arm) Feb. 11-Feb. 19:  Developed a cough which worsened, weakness, confusion, could not follow instruction, fell, no appetite, fever of 102.8 on Feb. 19, no taste Feb. 20: Emergency Room with diagnosis of Covid pneumonia.  Given usual Covid treatment.  Became very confused, combatative, etc. Feb. 21:  Placed on ventilator Mar. 1:  Ventilator removed.  Patient expired."
	"1090464-1"	"1090464-1"	"BLOOD TEST"	"10061726"	"65-79 years"	"65-79"	"Feb. 10:  Moderna Vaccination #1 Administered (arm) Feb. 11-Feb. 19:  Developed a cough which worsened, weakness, confusion, could not follow instruction, fell, no appetite, fever of 102.8 on Feb. 19, no taste Feb. 20: Emergency Room with diagnosis of Covid pneumonia.  Given usual Covid treatment.  Became very confused, combatative, etc. Feb. 21:  Placed on ventilator Mar. 1:  Ventilator removed.  Patient expired."
	"1090464-1"	"1090464-1"	"CHEST X-RAY"	"10008498"	"65-79 years"	"65-79"	"Feb. 10:  Moderna Vaccination #1 Administered (arm) Feb. 11-Feb. 19:  Developed a cough which worsened, weakness, confusion, could not follow instruction, fell, no appetite, fever of 102.8 on Feb. 19, no taste Feb. 20: Emergency Room with diagnosis of Covid pneumonia.  Given usual Covid treatment.  Became very confused, combatative, etc. Feb. 21:  Placed on ventilator Mar. 1:  Ventilator removed.  Patient expired."
	"1090464-1"	"1090464-1"	"COMPUTERISED TOMOGRAM THORAX"	"10053875"	"65-79 years"	"65-79"	"Feb. 10:  Moderna Vaccination #1 Administered (arm) Feb. 11-Feb. 19:  Developed a cough which worsened, weakness, confusion, could not follow instruction, fell, no appetite, fever of 102.8 on Feb. 19, no taste Feb. 20: Emergency Room with diagnosis of Covid pneumonia.  Given usual Covid treatment.  Became very confused, combatative, etc. Feb. 21:  Placed on ventilator Mar. 1:  Ventilator removed.  Patient expired."
	"1090464-1"	"1090464-1"	"CONFUSIONAL STATE"	"10010305"	"65-79 years"	"65-79"	"Feb. 10:  Moderna Vaccination #1 Administered (arm) Feb. 11-Feb. 19:  Developed a cough which worsened, weakness, confusion, could not follow instruction, fell, no appetite, fever of 102.8 on Feb. 19, no taste Feb. 20: Emergency Room with diagnosis of Covid pneumonia.  Given usual Covid treatment.  Became very confused, combatative, etc. Feb. 21:  Placed on ventilator Mar. 1:  Ventilator removed.  Patient expired."
	"1090464-1"	"1090464-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Feb. 10:  Moderna Vaccination #1 Administered (arm) Feb. 11-Feb. 19:  Developed a cough which worsened, weakness, confusion, could not follow instruction, fell, no appetite, fever of 102.8 on Feb. 19, no taste Feb. 20: Emergency Room with diagnosis of Covid pneumonia.  Given usual Covid treatment.  Became very confused, combatative, etc. Feb. 21:  Placed on ventilator Mar. 1:  Ventilator removed.  Patient expired."
	"1090464-1"	"1090464-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Feb. 10:  Moderna Vaccination #1 Administered (arm) Feb. 11-Feb. 19:  Developed a cough which worsened, weakness, confusion, could not follow instruction, fell, no appetite, fever of 102.8 on Feb. 19, no taste Feb. 20: Emergency Room with diagnosis of Covid pneumonia.  Given usual Covid treatment.  Became very confused, combatative, etc. Feb. 21:  Placed on ventilator Mar. 1:  Ventilator removed.  Patient expired."
	"1090464-1"	"1090464-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Feb. 10:  Moderna Vaccination #1 Administered (arm) Feb. 11-Feb. 19:  Developed a cough which worsened, weakness, confusion, could not follow instruction, fell, no appetite, fever of 102.8 on Feb. 19, no taste Feb. 20: Emergency Room with diagnosis of Covid pneumonia.  Given usual Covid treatment.  Became very confused, combatative, etc. Feb. 21:  Placed on ventilator Mar. 1:  Ventilator removed.  Patient expired."
	"1090464-1"	"1090464-1"	"DECREASED APPETITE"	"10061428"	"65-79 years"	"65-79"	"Feb. 10:  Moderna Vaccination #1 Administered (arm) Feb. 11-Feb. 19:  Developed a cough which worsened, weakness, confusion, could not follow instruction, fell, no appetite, fever of 102.8 on Feb. 19, no taste Feb. 20: Emergency Room with diagnosis of Covid pneumonia.  Given usual Covid treatment.  Became very confused, combatative, etc. Feb. 21:  Placed on ventilator Mar. 1:  Ventilator removed.  Patient expired."
	"1090464-1"	"1090464-1"	"FALL"	"10016173"	"65-79 years"	"65-79"	"Feb. 10:  Moderna Vaccination #1 Administered (arm) Feb. 11-Feb. 19:  Developed a cough which worsened, weakness, confusion, could not follow instruction, fell, no appetite, fever of 102.8 on Feb. 19, no taste Feb. 20: Emergency Room with diagnosis of Covid pneumonia.  Given usual Covid treatment.  Became very confused, combatative, etc. Feb. 21:  Placed on ventilator Mar. 1:  Ventilator removed.  Patient expired."
	"1090464-1"	"1090464-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Feb. 10:  Moderna Vaccination #1 Administered (arm) Feb. 11-Feb. 19:  Developed a cough which worsened, weakness, confusion, could not follow instruction, fell, no appetite, fever of 102.8 on Feb. 19, no taste Feb. 20: Emergency Room with diagnosis of Covid pneumonia.  Given usual Covid treatment.  Became very confused, combatative, etc. Feb. 21:  Placed on ventilator Mar. 1:  Ventilator removed.  Patient expired."
	"1090464-1"	"1090464-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"Feb. 10:  Moderna Vaccination #1 Administered (arm) Feb. 11-Feb. 19:  Developed a cough which worsened, weakness, confusion, could not follow instruction, fell, no appetite, fever of 102.8 on Feb. 19, no taste Feb. 20: Emergency Room with diagnosis of Covid pneumonia.  Given usual Covid treatment.  Became very confused, combatative, etc. Feb. 21:  Placed on ventilator Mar. 1:  Ventilator removed.  Patient expired."
	"1090862-1"	"1090862-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"DEATH-My Mother received her second Pfizer vaccine on Thursday, February 18, 2021 and died three days later on Sunday, February 21, 2021, after being admitted to the intensive care unit at  Hospital.  After developing an adverse reaction that started with nausea and then got progressively worse, including vomiting blood, Mom was rushed to the emergency room where she was tested for Covid-19 due to hospital policy (neg. result) and admitted to the intensive care unit.  Mother died on Sunday, February 21, 2021.    NOTE:  Mother was doing well with her heart and renal conditions until she received the second dose of the Pfizer Covid-19 vaccine on February 18, 2021, directly or indirectly causing her death three days later on February 21, 2021.  It is unfortunate that we are all advised (sometimes ill advised), particularly those with underlying conditions, to get vaccinated without the benefits of knowing when the vaccine can cause more harm than good.  For obvious reasons, the approval of covid vaccines was rushed and thus the Pfizer and Moderna Studies are not thorough and lack in data to support an all call for everyone to get vaccinated in the name of herd immunity.  Without the appropriate data, My Mother is DEAD!  Sadly, there are probably more unreported deaths caused by the vaccine.  While you have immunity from liability, you still have a moral obligation to collect data and advise accordingly.    My goal is to save lives by sharing my mother?s personal experience and death after receiving the vaccine with everyone I know through every available resource.  It is unconscionable that I have to shoulder the burden of getting the facts out about your vaccine so that individuals with underlying conditions can make a proper, informed decision about getting vaccinated.  Sadly, I receive over 100 questions a day via social media from individuals inquiring about whether or not they or their loved ones should opt for the vaccine.  I am not a medical professional?this is your job!  Until you assume responsibility, I will continue advising anyone with heart and/or renal conditions to stay away from any and all covid vaccinations.  Instead of the massive all call for vaccinations, we need further information and data from additional studies that will give more insight as to when the vaccine can cause more harm than good, as in My Mother?s case."
	"1090862-1"	"1090862-1"	"HAEMATEMESIS"	"10018830"	"65-79 years"	"65-79"	"DEATH-My Mother received her second Pfizer vaccine on Thursday, February 18, 2021 and died three days later on Sunday, February 21, 2021, after being admitted to the intensive care unit at  Hospital.  After developing an adverse reaction that started with nausea and then got progressively worse, including vomiting blood, Mom was rushed to the emergency room where she was tested for Covid-19 due to hospital policy (neg. result) and admitted to the intensive care unit.  Mother died on Sunday, February 21, 2021.    NOTE:  Mother was doing well with her heart and renal conditions until she received the second dose of the Pfizer Covid-19 vaccine on February 18, 2021, directly or indirectly causing her death three days later on February 21, 2021.  It is unfortunate that we are all advised (sometimes ill advised), particularly those with underlying conditions, to get vaccinated without the benefits of knowing when the vaccine can cause more harm than good.  For obvious reasons, the approval of covid vaccines was rushed and thus the Pfizer and Moderna Studies are not thorough and lack in data to support an all call for everyone to get vaccinated in the name of herd immunity.  Without the appropriate data, My Mother is DEAD!  Sadly, there are probably more unreported deaths caused by the vaccine.  While you have immunity from liability, you still have a moral obligation to collect data and advise accordingly.    My goal is to save lives by sharing my mother?s personal experience and death after receiving the vaccine with everyone I know through every available resource.  It is unconscionable that I have to shoulder the burden of getting the facts out about your vaccine so that individuals with underlying conditions can make a proper, informed decision about getting vaccinated.  Sadly, I receive over 100 questions a day via social media from individuals inquiring about whether or not they or their loved ones should opt for the vaccine.  I am not a medical professional?this is your job!  Until you assume responsibility, I will continue advising anyone with heart and/or renal conditions to stay away from any and all covid vaccinations.  Instead of the massive all call for vaccinations, we need further information and data from additional studies that will give more insight as to when the vaccine can cause more harm than good, as in My Mother?s case."
	"1090862-1"	"1090862-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"DEATH-My Mother received her second Pfizer vaccine on Thursday, February 18, 2021 and died three days later on Sunday, February 21, 2021, after being admitted to the intensive care unit at  Hospital.  After developing an adverse reaction that started with nausea and then got progressively worse, including vomiting blood, Mom was rushed to the emergency room where she was tested for Covid-19 due to hospital policy (neg. result) and admitted to the intensive care unit.  Mother died on Sunday, February 21, 2021.    NOTE:  Mother was doing well with her heart and renal conditions until she received the second dose of the Pfizer Covid-19 vaccine on February 18, 2021, directly or indirectly causing her death three days later on February 21, 2021.  It is unfortunate that we are all advised (sometimes ill advised), particularly those with underlying conditions, to get vaccinated without the benefits of knowing when the vaccine can cause more harm than good.  For obvious reasons, the approval of covid vaccines was rushed and thus the Pfizer and Moderna Studies are not thorough and lack in data to support an all call for everyone to get vaccinated in the name of herd immunity.  Without the appropriate data, My Mother is DEAD!  Sadly, there are probably more unreported deaths caused by the vaccine.  While you have immunity from liability, you still have a moral obligation to collect data and advise accordingly.    My goal is to save lives by sharing my mother?s personal experience and death after receiving the vaccine with everyone I know through every available resource.  It is unconscionable that I have to shoulder the burden of getting the facts out about your vaccine so that individuals with underlying conditions can make a proper, informed decision about getting vaccinated.  Sadly, I receive over 100 questions a day via social media from individuals inquiring about whether or not they or their loved ones should opt for the vaccine.  I am not a medical professional?this is your job!  Until you assume responsibility, I will continue advising anyone with heart and/or renal conditions to stay away from any and all covid vaccinations.  Instead of the massive all call for vaccinations, we need further information and data from additional studies that will give more insight as to when the vaccine can cause more harm than good, as in My Mother?s case."
	"1090862-1"	"1090862-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"DEATH-My Mother received her second Pfizer vaccine on Thursday, February 18, 2021 and died three days later on Sunday, February 21, 2021, after being admitted to the intensive care unit at  Hospital.  After developing an adverse reaction that started with nausea and then got progressively worse, including vomiting blood, Mom was rushed to the emergency room where she was tested for Covid-19 due to hospital policy (neg. result) and admitted to the intensive care unit.  Mother died on Sunday, February 21, 2021.    NOTE:  Mother was doing well with her heart and renal conditions until she received the second dose of the Pfizer Covid-19 vaccine on February 18, 2021, directly or indirectly causing her death three days later on February 21, 2021.  It is unfortunate that we are all advised (sometimes ill advised), particularly those with underlying conditions, to get vaccinated without the benefits of knowing when the vaccine can cause more harm than good.  For obvious reasons, the approval of covid vaccines was rushed and thus the Pfizer and Moderna Studies are not thorough and lack in data to support an all call for everyone to get vaccinated in the name of herd immunity.  Without the appropriate data, My Mother is DEAD!  Sadly, there are probably more unreported deaths caused by the vaccine.  While you have immunity from liability, you still have a moral obligation to collect data and advise accordingly.    My goal is to save lives by sharing my mother?s personal experience and death after receiving the vaccine with everyone I know through every available resource.  It is unconscionable that I have to shoulder the burden of getting the facts out about your vaccine so that individuals with underlying conditions can make a proper, informed decision about getting vaccinated.  Sadly, I receive over 100 questions a day via social media from individuals inquiring about whether or not they or their loved ones should opt for the vaccine.  I am not a medical professional?this is your job!  Until you assume responsibility, I will continue advising anyone with heart and/or renal conditions to stay away from any and all covid vaccinations.  Instead of the massive all call for vaccinations, we need further information and data from additional studies that will give more insight as to when the vaccine can cause more harm than good, as in My Mother?s case."
	"1090862-1"	"1090862-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	"DEATH-My Mother received her second Pfizer vaccine on Thursday, February 18, 2021 and died three days later on Sunday, February 21, 2021, after being admitted to the intensive care unit at  Hospital.  After developing an adverse reaction that started with nausea and then got progressively worse, including vomiting blood, Mom was rushed to the emergency room where she was tested for Covid-19 due to hospital policy (neg. result) and admitted to the intensive care unit.  Mother died on Sunday, February 21, 2021.    NOTE:  Mother was doing well with her heart and renal conditions until she received the second dose of the Pfizer Covid-19 vaccine on February 18, 2021, directly or indirectly causing her death three days later on February 21, 2021.  It is unfortunate that we are all advised (sometimes ill advised), particularly those with underlying conditions, to get vaccinated without the benefits of knowing when the vaccine can cause more harm than good.  For obvious reasons, the approval of covid vaccines was rushed and thus the Pfizer and Moderna Studies are not thorough and lack in data to support an all call for everyone to get vaccinated in the name of herd immunity.  Without the appropriate data, My Mother is DEAD!  Sadly, there are probably more unreported deaths caused by the vaccine.  While you have immunity from liability, you still have a moral obligation to collect data and advise accordingly.    My goal is to save lives by sharing my mother?s personal experience and death after receiving the vaccine with everyone I know through every available resource.  It is unconscionable that I have to shoulder the burden of getting the facts out about your vaccine so that individuals with underlying conditions can make a proper, informed decision about getting vaccinated.  Sadly, I receive over 100 questions a day via social media from individuals inquiring about whether or not they or their loved ones should opt for the vaccine.  I am not a medical professional?this is your job!  Until you assume responsibility, I will continue advising anyone with heart and/or renal conditions to stay away from any and all covid vaccinations.  Instead of the massive all call for vaccinations, we need further information and data from additional studies that will give more insight as to when the vaccine can cause more harm than good, as in My Mother?s case."
	"1091439-1"	"1091439-1"	"CEREBRAL HAEMORRHAGE"	"10008111"	"65-79 years"	"65-79"	"fell/passed out (unknown) at home, taken by ambulance to local hospital, small bleed noted on CT scan, transferred to tertiary care center, f/u scan after 6 hours unchanged. Sent home. next morning unresponsive, transported back to tertiary care center. required ventilation en route.. massive cerebral hemorrhage noted on CT scan in different area. due to advanced dementia and unresponsiveness life support removed around 9pm that night. passed away at 9am on 3/1."
	"1091439-1"	"1091439-1"	"COMPUTERISED TOMOGRAM ABNORMAL"	"10010235"	"65-79 years"	"65-79"	"fell/passed out (unknown) at home, taken by ambulance to local hospital, small bleed noted on CT scan, transferred to tertiary care center, f/u scan after 6 hours unchanged. Sent home. next morning unresponsive, transported back to tertiary care center. required ventilation en route.. massive cerebral hemorrhage noted on CT scan in different area. due to advanced dementia and unresponsiveness life support removed around 9pm that night. passed away at 9am on 3/1."
	"1091439-1"	"1091439-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"fell/passed out (unknown) at home, taken by ambulance to local hospital, small bleed noted on CT scan, transferred to tertiary care center, f/u scan after 6 hours unchanged. Sent home. next morning unresponsive, transported back to tertiary care center. required ventilation en route.. massive cerebral hemorrhage noted on CT scan in different area. due to advanced dementia and unresponsiveness life support removed around 9pm that night. passed away at 9am on 3/1."
	"1091439-1"	"1091439-1"	"DEMENTIA"	"10012267"	"65-79 years"	"65-79"	"fell/passed out (unknown) at home, taken by ambulance to local hospital, small bleed noted on CT scan, transferred to tertiary care center, f/u scan after 6 hours unchanged. Sent home. next morning unresponsive, transported back to tertiary care center. required ventilation en route.. massive cerebral hemorrhage noted on CT scan in different area. due to advanced dementia and unresponsiveness life support removed around 9pm that night. passed away at 9am on 3/1."
	"1091439-1"	"1091439-1"	"FALL"	"10016173"	"65-79 years"	"65-79"	"fell/passed out (unknown) at home, taken by ambulance to local hospital, small bleed noted on CT scan, transferred to tertiary care center, f/u scan after 6 hours unchanged. Sent home. next morning unresponsive, transported back to tertiary care center. required ventilation en route.. massive cerebral hemorrhage noted on CT scan in different area. due to advanced dementia and unresponsiveness life support removed around 9pm that night. passed away at 9am on 3/1."
	"1091439-1"	"1091439-1"	"HAEMORRHAGE"	"10055798"	"65-79 years"	"65-79"	"fell/passed out (unknown) at home, taken by ambulance to local hospital, small bleed noted on CT scan, transferred to tertiary care center, f/u scan after 6 hours unchanged. Sent home. next morning unresponsive, transported back to tertiary care center. required ventilation en route.. massive cerebral hemorrhage noted on CT scan in different area. due to advanced dementia and unresponsiveness life support removed around 9pm that night. passed away at 9am on 3/1."
	"1091439-1"	"1091439-1"	"LOSS OF CONSCIOUSNESS"	"10024855"	"65-79 years"	"65-79"	"fell/passed out (unknown) at home, taken by ambulance to local hospital, small bleed noted on CT scan, transferred to tertiary care center, f/u scan after 6 hours unchanged. Sent home. next morning unresponsive, transported back to tertiary care center. required ventilation en route.. massive cerebral hemorrhage noted on CT scan in different area. due to advanced dementia and unresponsiveness life support removed around 9pm that night. passed away at 9am on 3/1."
	"1091439-1"	"1091439-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"fell/passed out (unknown) at home, taken by ambulance to local hospital, small bleed noted on CT scan, transferred to tertiary care center, f/u scan after 6 hours unchanged. Sent home. next morning unresponsive, transported back to tertiary care center. required ventilation en route.. massive cerebral hemorrhage noted on CT scan in different area. due to advanced dementia and unresponsiveness life support removed around 9pm that night. passed away at 9am on 3/1."
	"1091439-1"	"1091439-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"fell/passed out (unknown) at home, taken by ambulance to local hospital, small bleed noted on CT scan, transferred to tertiary care center, f/u scan after 6 hours unchanged. Sent home. next morning unresponsive, transported back to tertiary care center. required ventilation en route.. massive cerebral hemorrhage noted on CT scan in different area. due to advanced dementia and unresponsiveness life support removed around 9pm that night. passed away at 9am on 3/1."
	"1092328-1"	"1092328-1"	"ANTICONVULSANT DRUG LEVEL INCREASED"	"10057856"	"65-79 years"	"65-79"	""Patient appeared alert, oriented and completed everyday normal activates 3 days after receiving vaccine on a Wednesday afternoon, Jan 27th 2021 at 4:00 p.m. . Went to bed as usual on Sunday night Jan 31st 2021 at 9:30 p.m., husband found patient on couch sitting upright, unresponsive at 4:00 a.m. Patient's daughter came over to the house approx. 8 minutes later. Preformed CPR for 3-5 minutes, pt had a pulse. The ambulance was called prior to daughter arriving at the house. Ambulance arrived at 4:40 a.m. took pt to Hospital by 5:00a.m.  Pt declared ""brain dead""""
	"1092328-1"	"1092328-1"	"BLOOD LACTIC ACID INCREASED"	"10005635"	"65-79 years"	"65-79"	""Patient appeared alert, oriented and completed everyday normal activates 3 days after receiving vaccine on a Wednesday afternoon, Jan 27th 2021 at 4:00 p.m. . Went to bed as usual on Sunday night Jan 31st 2021 at 9:30 p.m., husband found patient on couch sitting upright, unresponsive at 4:00 a.m. Patient's daughter came over to the house approx. 8 minutes later. Preformed CPR for 3-5 minutes, pt had a pulse. The ambulance was called prior to daughter arriving at the house. Ambulance arrived at 4:40 a.m. took pt to Hospital by 5:00a.m.  Pt declared ""brain dead""""
	"1092328-1"	"1092328-1"	"BRAIN DEATH"	"10049054"	"65-79 years"	"65-79"	""Patient appeared alert, oriented and completed everyday normal activates 3 days after receiving vaccine on a Wednesday afternoon, Jan 27th 2021 at 4:00 p.m. . Went to bed as usual on Sunday night Jan 31st 2021 at 9:30 p.m., husband found patient on couch sitting upright, unresponsive at 4:00 a.m. Patient's daughter came over to the house approx. 8 minutes later. Preformed CPR for 3-5 minutes, pt had a pulse. The ambulance was called prior to daughter arriving at the house. Ambulance arrived at 4:40 a.m. took pt to Hospital by 5:00a.m.  Pt declared ""brain dead""""
	"1092328-1"	"1092328-1"	"COMPUTERISED TOMOGRAM HEAD NORMAL"	"10072167"	"65-79 years"	"65-79"	""Patient appeared alert, oriented and completed everyday normal activates 3 days after receiving vaccine on a Wednesday afternoon, Jan 27th 2021 at 4:00 p.m. . Went to bed as usual on Sunday night Jan 31st 2021 at 9:30 p.m., husband found patient on couch sitting upright, unresponsive at 4:00 a.m. Patient's daughter came over to the house approx. 8 minutes later. Preformed CPR for 3-5 minutes, pt had a pulse. The ambulance was called prior to daughter arriving at the house. Ambulance arrived at 4:40 a.m. took pt to Hospital by 5:00a.m.  Pt declared ""brain dead""""
	"1092328-1"	"1092328-1"	"ELECTROCARDIOGRAM NORMAL"	"10014373"	"65-79 years"	"65-79"	""Patient appeared alert, oriented and completed everyday normal activates 3 days after receiving vaccine on a Wednesday afternoon, Jan 27th 2021 at 4:00 p.m. . Went to bed as usual on Sunday night Jan 31st 2021 at 9:30 p.m., husband found patient on couch sitting upright, unresponsive at 4:00 a.m. Patient's daughter came over to the house approx. 8 minutes later. Preformed CPR for 3-5 minutes, pt had a pulse. The ambulance was called prior to daughter arriving at the house. Ambulance arrived at 4:40 a.m. took pt to Hospital by 5:00a.m.  Pt declared ""brain dead""""
	"1092328-1"	"1092328-1"	"ELECTROENCEPHALOGRAM ABNORMAL"	"10014408"	"65-79 years"	"65-79"	""Patient appeared alert, oriented and completed everyday normal activates 3 days after receiving vaccine on a Wednesday afternoon, Jan 27th 2021 at 4:00 p.m. . Went to bed as usual on Sunday night Jan 31st 2021 at 9:30 p.m., husband found patient on couch sitting upright, unresponsive at 4:00 a.m. Patient's daughter came over to the house approx. 8 minutes later. Preformed CPR for 3-5 minutes, pt had a pulse. The ambulance was called prior to daughter arriving at the house. Ambulance arrived at 4:40 a.m. took pt to Hospital by 5:00a.m.  Pt declared ""brain dead""""
	"1092328-1"	"1092328-1"	"FULL BLOOD COUNT NORMAL"	"10017414"	"65-79 years"	"65-79"	""Patient appeared alert, oriented and completed everyday normal activates 3 days after receiving vaccine on a Wednesday afternoon, Jan 27th 2021 at 4:00 p.m. . Went to bed as usual on Sunday night Jan 31st 2021 at 9:30 p.m., husband found patient on couch sitting upright, unresponsive at 4:00 a.m. Patient's daughter came over to the house approx. 8 minutes later. Preformed CPR for 3-5 minutes, pt had a pulse. The ambulance was called prior to daughter arriving at the house. Ambulance arrived at 4:40 a.m. took pt to Hospital by 5:00a.m.  Pt declared ""brain dead""""
	"1092328-1"	"1092328-1"	"MAGNETIC RESONANCE IMAGING HEAD NORMAL"	"10085257"	"65-79 years"	"65-79"	""Patient appeared alert, oriented and completed everyday normal activates 3 days after receiving vaccine on a Wednesday afternoon, Jan 27th 2021 at 4:00 p.m. . Went to bed as usual on Sunday night Jan 31st 2021 at 9:30 p.m., husband found patient on couch sitting upright, unresponsive at 4:00 a.m. Patient's daughter came over to the house approx. 8 minutes later. Preformed CPR for 3-5 minutes, pt had a pulse. The ambulance was called prior to daughter arriving at the house. Ambulance arrived at 4:40 a.m. took pt to Hospital by 5:00a.m.  Pt declared ""brain dead""""
	"1092328-1"	"1092328-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	""Patient appeared alert, oriented and completed everyday normal activates 3 days after receiving vaccine on a Wednesday afternoon, Jan 27th 2021 at 4:00 p.m. . Went to bed as usual on Sunday night Jan 31st 2021 at 9:30 p.m., husband found patient on couch sitting upright, unresponsive at 4:00 a.m. Patient's daughter came over to the house approx. 8 minutes later. Preformed CPR for 3-5 minutes, pt had a pulse. The ambulance was called prior to daughter arriving at the house. Ambulance arrived at 4:40 a.m. took pt to Hospital by 5:00a.m.  Pt declared ""brain dead""""
	"1092328-1"	"1092328-1"	"SCAN WITH CONTRAST NORMAL"	"10062153"	"65-79 years"	"65-79"	""Patient appeared alert, oriented and completed everyday normal activates 3 days after receiving vaccine on a Wednesday afternoon, Jan 27th 2021 at 4:00 p.m. . Went to bed as usual on Sunday night Jan 31st 2021 at 9:30 p.m., husband found patient on couch sitting upright, unresponsive at 4:00 a.m. Patient's daughter came over to the house approx. 8 minutes later. Preformed CPR for 3-5 minutes, pt had a pulse. The ambulance was called prior to daughter arriving at the house. Ambulance arrived at 4:40 a.m. took pt to Hospital by 5:00a.m.  Pt declared ""brain dead""""
	"1092328-1"	"1092328-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	""Patient appeared alert, oriented and completed everyday normal activates 3 days after receiving vaccine on a Wednesday afternoon, Jan 27th 2021 at 4:00 p.m. . Went to bed as usual on Sunday night Jan 31st 2021 at 9:30 p.m., husband found patient on couch sitting upright, unresponsive at 4:00 a.m. Patient's daughter came over to the house approx. 8 minutes later. Preformed CPR for 3-5 minutes, pt had a pulse. The ambulance was called prior to daughter arriving at the house. Ambulance arrived at 4:40 a.m. took pt to Hospital by 5:00a.m.  Pt declared ""brain dead""""
	"1094638-1"	"1094638-1"	"CONFUSIONAL STATE"	"10010305"	"65-79 years"	"65-79"	"Exposure to Covid 19 either on the date of vaccine (2/13/21) or shortly thereafter.  Symptoms of Covid started on Monday (2/15) early morning following shot.  Dr. ordered Covid test on Weds. (2/17). Taken by ambulance to Hospital, approx. 7 pm on Saturday (2/20) with dehydration, low oxygen levels, confusion, shaking and cough.  Admitted to hospital with threats of ventilator up until Weds (2/24) when he was intubated, proned and FINALLY given hydration via IV fluids.  He went into kidney failure on Thursday (2/25) and put on dialysis.  Other organs began shutting down and was taken off the ventilator on Friday (2/26) and did not recover.  He passed away just before 4:00 p.m. on 2/26/21."
	"1094638-1"	"1094638-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Exposure to Covid 19 either on the date of vaccine (2/13/21) or shortly thereafter.  Symptoms of Covid started on Monday (2/15) early morning following shot.  Dr. ordered Covid test on Weds. (2/17). Taken by ambulance to Hospital, approx. 7 pm on Saturday (2/20) with dehydration, low oxygen levels, confusion, shaking and cough.  Admitted to hospital with threats of ventilator up until Weds (2/24) when he was intubated, proned and FINALLY given hydration via IV fluids.  He went into kidney failure on Thursday (2/25) and put on dialysis.  Other organs began shutting down and was taken off the ventilator on Friday (2/26) and did not recover.  He passed away just before 4:00 p.m. on 2/26/21."
	"1094638-1"	"1094638-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Exposure to Covid 19 either on the date of vaccine (2/13/21) or shortly thereafter.  Symptoms of Covid started on Monday (2/15) early morning following shot.  Dr. ordered Covid test on Weds. (2/17). Taken by ambulance to Hospital, approx. 7 pm on Saturday (2/20) with dehydration, low oxygen levels, confusion, shaking and cough.  Admitted to hospital with threats of ventilator up until Weds (2/24) when he was intubated, proned and FINALLY given hydration via IV fluids.  He went into kidney failure on Thursday (2/25) and put on dialysis.  Other organs began shutting down and was taken off the ventilator on Friday (2/26) and did not recover.  He passed away just before 4:00 p.m. on 2/26/21."
	"1094638-1"	"1094638-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Exposure to Covid 19 either on the date of vaccine (2/13/21) or shortly thereafter.  Symptoms of Covid started on Monday (2/15) early morning following shot.  Dr. ordered Covid test on Weds. (2/17). Taken by ambulance to Hospital, approx. 7 pm on Saturday (2/20) with dehydration, low oxygen levels, confusion, shaking and cough.  Admitted to hospital with threats of ventilator up until Weds (2/24) when he was intubated, proned and FINALLY given hydration via IV fluids.  He went into kidney failure on Thursday (2/25) and put on dialysis.  Other organs began shutting down and was taken off the ventilator on Friday (2/26) and did not recover.  He passed away just before 4:00 p.m. on 2/26/21."
	"1094638-1"	"1094638-1"	"DEHYDRATION"	"10012174"	"65-79 years"	"65-79"	"Exposure to Covid 19 either on the date of vaccine (2/13/21) or shortly thereafter.  Symptoms of Covid started on Monday (2/15) early morning following shot.  Dr. ordered Covid test on Weds. (2/17). Taken by ambulance to Hospital, approx. 7 pm on Saturday (2/20) with dehydration, low oxygen levels, confusion, shaking and cough.  Admitted to hospital with threats of ventilator up until Weds (2/24) when he was intubated, proned and FINALLY given hydration via IV fluids.  He went into kidney failure on Thursday (2/25) and put on dialysis.  Other organs began shutting down and was taken off the ventilator on Friday (2/26) and did not recover.  He passed away just before 4:00 p.m. on 2/26/21."
	"1094638-1"	"1094638-1"	"DIALYSIS"	"10061105"	"65-79 years"	"65-79"	"Exposure to Covid 19 either on the date of vaccine (2/13/21) or shortly thereafter.  Symptoms of Covid started on Monday (2/15) early morning following shot.  Dr. ordered Covid test on Weds. (2/17). Taken by ambulance to Hospital, approx. 7 pm on Saturday (2/20) with dehydration, low oxygen levels, confusion, shaking and cough.  Admitted to hospital with threats of ventilator up until Weds (2/24) when he was intubated, proned and FINALLY given hydration via IV fluids.  He went into kidney failure on Thursday (2/25) and put on dialysis.  Other organs began shutting down and was taken off the ventilator on Friday (2/26) and did not recover.  He passed away just before 4:00 p.m. on 2/26/21."
	"1094638-1"	"1094638-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Exposure to Covid 19 either on the date of vaccine (2/13/21) or shortly thereafter.  Symptoms of Covid started on Monday (2/15) early morning following shot.  Dr. ordered Covid test on Weds. (2/17). Taken by ambulance to Hospital, approx. 7 pm on Saturday (2/20) with dehydration, low oxygen levels, confusion, shaking and cough.  Admitted to hospital with threats of ventilator up until Weds (2/24) when he was intubated, proned and FINALLY given hydration via IV fluids.  He went into kidney failure on Thursday (2/25) and put on dialysis.  Other organs began shutting down and was taken off the ventilator on Friday (2/26) and did not recover.  He passed away just before 4:00 p.m. on 2/26/21."
	"1094638-1"	"1094638-1"	"EXPOSURE TO SARS-COV-2"	"10084456"	"65-79 years"	"65-79"	"Exposure to Covid 19 either on the date of vaccine (2/13/21) or shortly thereafter.  Symptoms of Covid started on Monday (2/15) early morning following shot.  Dr. ordered Covid test on Weds. (2/17). Taken by ambulance to Hospital, approx. 7 pm on Saturday (2/20) with dehydration, low oxygen levels, confusion, shaking and cough.  Admitted to hospital with threats of ventilator up until Weds (2/24) when he was intubated, proned and FINALLY given hydration via IV fluids.  He went into kidney failure on Thursday (2/25) and put on dialysis.  Other organs began shutting down and was taken off the ventilator on Friday (2/26) and did not recover.  He passed away just before 4:00 p.m. on 2/26/21."
	"1094638-1"	"1094638-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Exposure to Covid 19 either on the date of vaccine (2/13/21) or shortly thereafter.  Symptoms of Covid started on Monday (2/15) early morning following shot.  Dr. ordered Covid test on Weds. (2/17). Taken by ambulance to Hospital, approx. 7 pm on Saturday (2/20) with dehydration, low oxygen levels, confusion, shaking and cough.  Admitted to hospital with threats of ventilator up until Weds (2/24) when he was intubated, proned and FINALLY given hydration via IV fluids.  He went into kidney failure on Thursday (2/25) and put on dialysis.  Other organs began shutting down and was taken off the ventilator on Friday (2/26) and did not recover.  He passed away just before 4:00 p.m. on 2/26/21."
	"1094638-1"	"1094638-1"	"MULTIPLE ORGAN DYSFUNCTION SYNDROME"	"10077361"	"65-79 years"	"65-79"	"Exposure to Covid 19 either on the date of vaccine (2/13/21) or shortly thereafter.  Symptoms of Covid started on Monday (2/15) early morning following shot.  Dr. ordered Covid test on Weds. (2/17). Taken by ambulance to Hospital, approx. 7 pm on Saturday (2/20) with dehydration, low oxygen levels, confusion, shaking and cough.  Admitted to hospital with threats of ventilator up until Weds (2/24) when he was intubated, proned and FINALLY given hydration via IV fluids.  He went into kidney failure on Thursday (2/25) and put on dialysis.  Other organs began shutting down and was taken off the ventilator on Friday (2/26) and did not recover.  He passed away just before 4:00 p.m. on 2/26/21."
	"1094638-1"	"1094638-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"Exposure to Covid 19 either on the date of vaccine (2/13/21) or shortly thereafter.  Symptoms of Covid started on Monday (2/15) early morning following shot.  Dr. ordered Covid test on Weds. (2/17). Taken by ambulance to Hospital, approx. 7 pm on Saturday (2/20) with dehydration, low oxygen levels, confusion, shaking and cough.  Admitted to hospital with threats of ventilator up until Weds (2/24) when he was intubated, proned and FINALLY given hydration via IV fluids.  He went into kidney failure on Thursday (2/25) and put on dialysis.  Other organs began shutting down and was taken off the ventilator on Friday (2/26) and did not recover.  He passed away just before 4:00 p.m. on 2/26/21."
	"1094638-1"	"1094638-1"	"RENAL FAILURE"	"10038435"	"65-79 years"	"65-79"	"Exposure to Covid 19 either on the date of vaccine (2/13/21) or shortly thereafter.  Symptoms of Covid started on Monday (2/15) early morning following shot.  Dr. ordered Covid test on Weds. (2/17). Taken by ambulance to Hospital, approx. 7 pm on Saturday (2/20) with dehydration, low oxygen levels, confusion, shaking and cough.  Admitted to hospital with threats of ventilator up until Weds (2/24) when he was intubated, proned and FINALLY given hydration via IV fluids.  He went into kidney failure on Thursday (2/25) and put on dialysis.  Other organs began shutting down and was taken off the ventilator on Friday (2/26) and did not recover.  He passed away just before 4:00 p.m. on 2/26/21."
	"1094638-1"	"1094638-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Exposure to Covid 19 either on the date of vaccine (2/13/21) or shortly thereafter.  Symptoms of Covid started on Monday (2/15) early morning following shot.  Dr. ordered Covid test on Weds. (2/17). Taken by ambulance to Hospital, approx. 7 pm on Saturday (2/20) with dehydration, low oxygen levels, confusion, shaking and cough.  Admitted to hospital with threats of ventilator up until Weds (2/24) when he was intubated, proned and FINALLY given hydration via IV fluids.  He went into kidney failure on Thursday (2/25) and put on dialysis.  Other organs began shutting down and was taken off the ventilator on Friday (2/26) and did not recover.  He passed away just before 4:00 p.m. on 2/26/21."
	"1094638-1"	"1094638-1"	"TREMOR"	"10044565"	"65-79 years"	"65-79"	"Exposure to Covid 19 either on the date of vaccine (2/13/21) or shortly thereafter.  Symptoms of Covid started on Monday (2/15) early morning following shot.  Dr. ordered Covid test on Weds. (2/17). Taken by ambulance to Hospital, approx. 7 pm on Saturday (2/20) with dehydration, low oxygen levels, confusion, shaking and cough.  Admitted to hospital with threats of ventilator up until Weds (2/24) when he was intubated, proned and FINALLY given hydration via IV fluids.  He went into kidney failure on Thursday (2/25) and put on dialysis.  Other organs began shutting down and was taken off the ventilator on Friday (2/26) and did not recover.  He passed away just before 4:00 p.m. on 2/26/21."
	"1097000-1"	"1097000-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"No adverse events were immediately reported, but patient died on 7th day following vaccine"
	"1109535-1"	"1109535-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"My Father had a hemorrhagic stroke.  He passed away 13 days after receiving the second Modern?s vaccine."
	"1109535-1"	"1109535-1"	"HAEMORRHAGIC STROKE"	"10019016"	"65-79 years"	"65-79"	"My Father had a hemorrhagic stroke.  He passed away 13 days after receiving the second Modern?s vaccine."
	"1112701-1"	"1112701-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt received COVID19 shot on 3/12/2021. Pt passed away on 3/15/2021. Dr called us to inform us that our patient had passed away but he did not believe it was caused by the vaccination at this time."
	"1116540-1"	"1116540-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"DEATH- PHARMACY NOTIFIED 3/19/21 OF PATIENT DEATH ON 3/18/21, NO OTHER DETAILS KNOWN"
	"1126550-1"	"1126550-1"	"COMPUTERISED TOMOGRAM"	"10010234"	"65-79 years"	"65-79"	"Death; A spontaneous report was received from a consumer concerning a 66-year-old, female patient, who received Moderna's covid-19 vaccine (mRNA-1273) and died.   The patient's medical history included covid-19 infection on 04 Nov 2020. No relevant concomitant medications were mentioned.   On 28 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Batch number:unknown) intramuscularly for prophylaxis of COVID-19 infection.   On 09 Mar 2021, the patient died.  CT was done and did not find any atherosclerosis but found her lungs were whited out,heavily filled with fluid which he described could've been pulmonary edema. She had tested Covid positive back on 04 Nov 2020.    Treatment information was not provided.  Action taken with mRNA-1273 in response to the event was not applicable.  The outcome of the event was fatal.  The patient died on 09 Mar 2021 and the cause of death was unknown. An autopsy was planned on 11 Mar 2021.; Reporter's Comments: Very limited information regarding this event has been provided at this time.  Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death"
	"1126550-1"	"1126550-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death; A spontaneous report was received from a consumer concerning a 66-year-old, female patient, who received Moderna's covid-19 vaccine (mRNA-1273) and died.   The patient's medical history included covid-19 infection on 04 Nov 2020. No relevant concomitant medications were mentioned.   On 28 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Batch number:unknown) intramuscularly for prophylaxis of COVID-19 infection.   On 09 Mar 2021, the patient died.  CT was done and did not find any atherosclerosis but found her lungs were whited out,heavily filled with fluid which he described could've been pulmonary edema. She had tested Covid positive back on 04 Nov 2020.    Treatment information was not provided.  Action taken with mRNA-1273 in response to the event was not applicable.  The outcome of the event was fatal.  The patient died on 09 Mar 2021 and the cause of death was unknown. An autopsy was planned on 11 Mar 2021.; Reporter's Comments: Very limited information regarding this event has been provided at this time.  Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death"
	"1127657-1"	"1127657-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Cardiopulmonary arrest at home @ 1 hour after vaccine administration. CPR by EMS to today hospital for asystolic cardiac arrest. Pt. Intubated then terminally extubated"
	"1127657-1"	"1127657-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"65-79 years"	"65-79"	"Cardiopulmonary arrest at home @ 1 hour after vaccine administration. CPR by EMS to today hospital for asystolic cardiac arrest. Pt. Intubated then terminally extubated"
	"1127657-1"	"1127657-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Cardiopulmonary arrest at home @ 1 hour after vaccine administration. CPR by EMS to today hospital for asystolic cardiac arrest. Pt. Intubated then terminally extubated"
	"1127657-1"	"1127657-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Cardiopulmonary arrest at home @ 1 hour after vaccine administration. CPR by EMS to today hospital for asystolic cardiac arrest. Pt. Intubated then terminally extubated"
	"1130250-1"	"1130250-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient tested positive for Covid on 3/12/21 per hospital admission notes. Patient was admitted to the hospital on 3/16/2021 with Covid pneumonia. She passed away on 3/22/21."
	"1130250-1"	"1130250-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Patient tested positive for Covid on 3/12/21 per hospital admission notes. Patient was admitted to the hospital on 3/16/2021 with Covid pneumonia. She passed away on 3/22/21."
	"1130250-1"	"1130250-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient tested positive for Covid on 3/12/21 per hospital admission notes. Patient was admitted to the hospital on 3/16/2021 with Covid pneumonia. She passed away on 3/22/21."
	"1130250-1"	"1130250-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient tested positive for Covid on 3/12/21 per hospital admission notes. Patient was admitted to the hospital on 3/16/2021 with Covid pneumonia. She passed away on 3/22/21."
	"1131386-1"	"1131386-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"death"
	"1131556-1"	"1131556-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Diagnosis?s with TTP on March 12. Passes away on March 19 2021"
	"1131556-1"	"1131556-1"	"IMMUNE THROMBOCYTOPENIA"	"10083842"	"65-79 years"	"65-79"	"Diagnosis?s with TTP on March 12. Passes away on March 19 2021"
	"1131556-1"	"1131556-1"	"PLATELET COUNT DECREASED"	"10035528"	"65-79 years"	"65-79"	"Diagnosis?s with TTP on March 12. Passes away on March 19 2021"
	"1134002-1"	"1134002-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death 4 days after vaccination"
	"1135351-1"	"1135351-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"2/03/2021  Death.  No treatment.  Deceased."
	"1135351-1"	"1135351-1"	"TESTICULAR FAILURE"	"10043315"	"65-79 years"	"65-79"	"2/03/2021  Death.  No treatment.  Deceased."
	"1137994-1"	"1137994-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on Monday (March 22nd, 2021)"
	"1140716-1"	"1140716-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Approximately 30 minutes after vaccination the patient experienced a cardiac arrest. He was brought to the hospital where resuscitation efforts were continued but ultimately proved to be unsuccessful. The patient was pronounced deceased."
	"1140716-1"	"1140716-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Approximately 30 minutes after vaccination the patient experienced a cardiac arrest. He was brought to the hospital where resuscitation efforts were continued but ultimately proved to be unsuccessful. The patient was pronounced deceased."
	"1140716-1"	"1140716-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Approximately 30 minutes after vaccination the patient experienced a cardiac arrest. He was brought to the hospital where resuscitation efforts were continued but ultimately proved to be unsuccessful. The patient was pronounced deceased."
	"1148285-1"	"1148285-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death"
	"1152648-1"	"1152648-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Cardiac arrest resulting in death.  I actually do not know the name of the vaccine or which type it was it was her 2nd one and it occurred today at 1:30 pm"
	"1152648-1"	"1152648-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Cardiac arrest resulting in death.  I actually do not know the name of the vaccine or which type it was it was her 2nd one and it occurred today at 1:30 pm"
	"1157805-1"	"1157805-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient had the 2nd Vaccine on 3-25-2021 and Passed away on 3-28-2021. our tech found out.  No clue if it is related to the vaccine or not."
	"1158955-1"	"1158955-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Deceased"
	"1159573-1"	"1159573-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"He received his vaccine, had soreness in his arm.  Went to bed and around 2:00 AM his brother got a call from his dad (he lives upstairs from him in the same house) who said that something was wrong and he needed to go to the hospital.  The brother found him  sweating profusely, it appeared that the right side of his body was stiffening up, and they started to go out to the car to go to the hospital.  He started to go limp and he collapsed and tried to revive him, they called 9-1-1 and they tried to revive him as well without success and he died."
	"1159573-1"	"1159573-1"	"HYPERHIDROSIS"	"10020642"	"65-79 years"	"65-79"	"He received his vaccine, had soreness in his arm.  Went to bed and around 2:00 AM his brother got a call from his dad (he lives upstairs from him in the same house) who said that something was wrong and he needed to go to the hospital.  The brother found him  sweating profusely, it appeared that the right side of his body was stiffening up, and they started to go out to the car to go to the hospital.  He started to go limp and he collapsed and tried to revive him, they called 9-1-1 and they tried to revive him as well without success and he died."
	"1159573-1"	"1159573-1"	"HYPOTONIA"	"10021118"	"65-79 years"	"65-79"	"He received his vaccine, had soreness in his arm.  Went to bed and around 2:00 AM his brother got a call from his dad (he lives upstairs from him in the same house) who said that something was wrong and he needed to go to the hospital.  The brother found him  sweating profusely, it appeared that the right side of his body was stiffening up, and they started to go out to the car to go to the hospital.  He started to go limp and he collapsed and tried to revive him, they called 9-1-1 and they tried to revive him as well without success and he died."
	"1159573-1"	"1159573-1"	"MUSCULOSKELETAL STIFFNESS"	"10052904"	"65-79 years"	"65-79"	"He received his vaccine, had soreness in his arm.  Went to bed and around 2:00 AM his brother got a call from his dad (he lives upstairs from him in the same house) who said that something was wrong and he needed to go to the hospital.  The brother found him  sweating profusely, it appeared that the right side of his body was stiffening up, and they started to go out to the car to go to the hospital.  He started to go limp and he collapsed and tried to revive him, they called 9-1-1 and they tried to revive him as well without success and he died."
	"1159573-1"	"1159573-1"	"PAIN IN EXTREMITY"	"10033425"	"65-79 years"	"65-79"	"He received his vaccine, had soreness in his arm.  Went to bed and around 2:00 AM his brother got a call from his dad (he lives upstairs from him in the same house) who said that something was wrong and he needed to go to the hospital.  The brother found him  sweating profusely, it appeared that the right side of his body was stiffening up, and they started to go out to the car to go to the hospital.  He started to go limp and he collapsed and tried to revive him, they called 9-1-1 and they tried to revive him as well without success and he died."
	"1159573-1"	"1159573-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"He received his vaccine, had soreness in his arm.  Went to bed and around 2:00 AM his brother got a call from his dad (he lives upstairs from him in the same house) who said that something was wrong and he needed to go to the hospital.  The brother found him  sweating profusely, it appeared that the right side of his body was stiffening up, and they started to go out to the car to go to the hospital.  He started to go limp and he collapsed and tried to revive him, they called 9-1-1 and they tried to revive him as well without success and he died."
	"1159573-1"	"1159573-1"	"SYNCOPE"	"10042772"	"65-79 years"	"65-79"	"He received his vaccine, had soreness in his arm.  Went to bed and around 2:00 AM his brother got a call from his dad (he lives upstairs from him in the same house) who said that something was wrong and he needed to go to the hospital.  The brother found him  sweating profusely, it appeared that the right side of his body was stiffening up, and they started to go out to the car to go to the hospital.  He started to go limp and he collapsed and tried to revive him, they called 9-1-1 and they tried to revive him as well without success and he died."
	"1165132-1"	"1165132-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death; had vomited and was found unresponsive and covered in stool, intubated and then went in to PEA in the field and passed despite lengthy resuscitation."
	"1165132-1"	"1165132-1"	"DEFAECATION DISORDER"	"10079938"	"65-79 years"	"65-79"	"Death; had vomited and was found unresponsive and covered in stool, intubated and then went in to PEA in the field and passed despite lengthy resuscitation."
	"1165132-1"	"1165132-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Death; had vomited and was found unresponsive and covered in stool, intubated and then went in to PEA in the field and passed despite lengthy resuscitation."
	"1165132-1"	"1165132-1"	"LABORATORY TEST NORMAL"	"10054052"	"65-79 years"	"65-79"	"Death; had vomited and was found unresponsive and covered in stool, intubated and then went in to PEA in the field and passed despite lengthy resuscitation."
	"1165132-1"	"1165132-1"	"PULSELESS ELECTRICAL ACTIVITY"	"10058151"	"65-79 years"	"65-79"	"Death; had vomited and was found unresponsive and covered in stool, intubated and then went in to PEA in the field and passed despite lengthy resuscitation."
	"1165132-1"	"1165132-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"Death; had vomited and was found unresponsive and covered in stool, intubated and then went in to PEA in the field and passed despite lengthy resuscitation."
	"1165132-1"	"1165132-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"Death; had vomited and was found unresponsive and covered in stool, intubated and then went in to PEA in the field and passed despite lengthy resuscitation."
	"1169895-1"	"1169895-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death; 48 hours after vaccine"
	"1169913-1"	"1169913-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"65-79 years"	"65-79"	"none noted or reported after the injection"
	"1169913-1"	"1169913-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"none noted or reported after the injection"
	"1169913-1"	"1169913-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"none noted or reported after the injection"
	"1169913-1"	"1169913-1"	"TRANSFUSION"	"10066152"	"65-79 years"	"65-79"	"none noted or reported after the injection"
	"1180688-1"	"1180688-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Patient was vaccinated on 4/6/21 at 9:05 am.  Report received that patient was in the car on the way home from the vaccination and had chest pain and shortness of breath.  Patient called their primary care doctor who requested reporting to the nearest emergency room immediately.  Patient became unresponsive in the car.  Patient arrived in cardiac arrest (arrival time noted to be 4/6/21 at 10:54 am, CPR began. Patient was intubated in the ER, and received epinephrine, amiodarone, and was defibrillated several times per ACLS protocol.  Patient did not have return of spontaneous circulation and was subsequently pronounced. Per report, it was noted that patient was short of breath prior to receiving vaccination earlier in the day."
	"1180688-1"	"1180688-1"	"CARDIOVERSION"	"10007661"	"65-79 years"	"65-79"	"Patient was vaccinated on 4/6/21 at 9:05 am.  Report received that patient was in the car on the way home from the vaccination and had chest pain and shortness of breath.  Patient called their primary care doctor who requested reporting to the nearest emergency room immediately.  Patient became unresponsive in the car.  Patient arrived in cardiac arrest (arrival time noted to be 4/6/21 at 10:54 am, CPR began. Patient was intubated in the ER, and received epinephrine, amiodarone, and was defibrillated several times per ACLS protocol.  Patient did not have return of spontaneous circulation and was subsequently pronounced. Per report, it was noted that patient was short of breath prior to receiving vaccination earlier in the day."
	"1180688-1"	"1180688-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	"Patient was vaccinated on 4/6/21 at 9:05 am.  Report received that patient was in the car on the way home from the vaccination and had chest pain and shortness of breath.  Patient called their primary care doctor who requested reporting to the nearest emergency room immediately.  Patient became unresponsive in the car.  Patient arrived in cardiac arrest (arrival time noted to be 4/6/21 at 10:54 am, CPR began. Patient was intubated in the ER, and received epinephrine, amiodarone, and was defibrillated several times per ACLS protocol.  Patient did not have return of spontaneous circulation and was subsequently pronounced. Per report, it was noted that patient was short of breath prior to receiving vaccination earlier in the day."
	"1180688-1"	"1180688-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Patient was vaccinated on 4/6/21 at 9:05 am.  Report received that patient was in the car on the way home from the vaccination and had chest pain and shortness of breath.  Patient called their primary care doctor who requested reporting to the nearest emergency room immediately.  Patient became unresponsive in the car.  Patient arrived in cardiac arrest (arrival time noted to be 4/6/21 at 10:54 am, CPR began. Patient was intubated in the ER, and received epinephrine, amiodarone, and was defibrillated several times per ACLS protocol.  Patient did not have return of spontaneous circulation and was subsequently pronounced. Per report, it was noted that patient was short of breath prior to receiving vaccination earlier in the day."
	"1180688-1"	"1180688-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient was vaccinated on 4/6/21 at 9:05 am.  Report received that patient was in the car on the way home from the vaccination and had chest pain and shortness of breath.  Patient called their primary care doctor who requested reporting to the nearest emergency room immediately.  Patient became unresponsive in the car.  Patient arrived in cardiac arrest (arrival time noted to be 4/6/21 at 10:54 am, CPR began. Patient was intubated in the ER, and received epinephrine, amiodarone, and was defibrillated several times per ACLS protocol.  Patient did not have return of spontaneous circulation and was subsequently pronounced. Per report, it was noted that patient was short of breath prior to receiving vaccination earlier in the day."
	"1180688-1"	"1180688-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient was vaccinated on 4/6/21 at 9:05 am.  Report received that patient was in the car on the way home from the vaccination and had chest pain and shortness of breath.  Patient called their primary care doctor who requested reporting to the nearest emergency room immediately.  Patient became unresponsive in the car.  Patient arrived in cardiac arrest (arrival time noted to be 4/6/21 at 10:54 am, CPR began. Patient was intubated in the ER, and received epinephrine, amiodarone, and was defibrillated several times per ACLS protocol.  Patient did not have return of spontaneous circulation and was subsequently pronounced. Per report, it was noted that patient was short of breath prior to receiving vaccination earlier in the day."
	"1180688-1"	"1180688-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Patient was vaccinated on 4/6/21 at 9:05 am.  Report received that patient was in the car on the way home from the vaccination and had chest pain and shortness of breath.  Patient called their primary care doctor who requested reporting to the nearest emergency room immediately.  Patient became unresponsive in the car.  Patient arrived in cardiac arrest (arrival time noted to be 4/6/21 at 10:54 am, CPR began. Patient was intubated in the ER, and received epinephrine, amiodarone, and was defibrillated several times per ACLS protocol.  Patient did not have return of spontaneous circulation and was subsequently pronounced. Per report, it was noted that patient was short of breath prior to receiving vaccination earlier in the day."
	"1180688-1"	"1180688-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Patient was vaccinated on 4/6/21 at 9:05 am.  Report received that patient was in the car on the way home from the vaccination and had chest pain and shortness of breath.  Patient called their primary care doctor who requested reporting to the nearest emergency room immediately.  Patient became unresponsive in the car.  Patient arrived in cardiac arrest (arrival time noted to be 4/6/21 at 10:54 am, CPR began. Patient was intubated in the ER, and received epinephrine, amiodarone, and was defibrillated several times per ACLS protocol.  Patient did not have return of spontaneous circulation and was subsequently pronounced. Per report, it was noted that patient was short of breath prior to receiving vaccination earlier in the day."
	"1180688-1"	"1180688-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"Patient was vaccinated on 4/6/21 at 9:05 am.  Report received that patient was in the car on the way home from the vaccination and had chest pain and shortness of breath.  Patient called their primary care doctor who requested reporting to the nearest emergency room immediately.  Patient became unresponsive in the car.  Patient arrived in cardiac arrest (arrival time noted to be 4/6/21 at 10:54 am, CPR began. Patient was intubated in the ER, and received epinephrine, amiodarone, and was defibrillated several times per ACLS protocol.  Patient did not have return of spontaneous circulation and was subsequently pronounced. Per report, it was noted that patient was short of breath prior to receiving vaccination earlier in the day."
	"1181914-1"	"1181914-1"	"ACCIDENT"	"10000369"	"65-79 years"	"65-79"	"Patient entered Drug store to get his second Moderna COVID shot on 4/8/2021 at approx. 12:30pm. (First dose was 3/11/2021) He filled out his Pre-Vaccination Checklist for COVID-19 Vaccines and signed the consent. His form was reviewed and he was given his vaccine in his left deltoid. He then was given his CDC card and waited at least 15 minutes and then exited the building. At 1p.m he was in an accident on the main highway.  He was conscious after the accident, but later did pass away.  This information came from a Police Officer as no one at the pharmacy witnessed the accident."
	"1181914-1"	"1181914-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient entered Drug store to get his second Moderna COVID shot on 4/8/2021 at approx. 12:30pm. (First dose was 3/11/2021) He filled out his Pre-Vaccination Checklist for COVID-19 Vaccines and signed the consent. His form was reviewed and he was given his vaccine in his left deltoid. He then was given his CDC card and waited at least 15 minutes and then exited the building. At 1p.m he was in an accident on the main highway.  He was conscious after the accident, but later did pass away.  This information came from a Police Officer as no one at the pharmacy witnessed the accident."
	"1182018-1"	"1182018-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Death from cardiac arrest"
	"1182018-1"	"1182018-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death from cardiac arrest"
	"1185996-1"	"1185996-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	"My father complained of chest pains and then died two days after receiving the vaccine."
	"1185996-1"	"1185996-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"My father complained of chest pains and then died two days after receiving the vaccine."
	"1186275-1"	"1186275-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Died of Heart Attack unexpectedly day following vaccine"
	"1186275-1"	"1186275-1"	"MYOCARDIAL INFARCTION"	"10028596"	"65-79 years"	"65-79"	"Died of Heart Attack unexpectedly day following vaccine"
	"1188040-1"	"1188040-1"	"CEREBRAL HAEMORRHAGE"	"10008111"	"65-79 years"	"65-79"	"nontraumatic subcortical hemorrhage of left cerebral hemisphere resulting in death"
	"1188040-1"	"1188040-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"nontraumatic subcortical hemorrhage of left cerebral hemisphere resulting in death"
	"1188519-1"	"1188519-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"On 3/29/21 at 11:00pm my dad began having chills and uncontrollable shaking. My mother contacted Pfizer who instructed us to alternate Tylenol and Motrin. Tylenol given and Motrin given 4 hours later as instructed by Pfizer. On 3/30/21 around 11:10am my dad was found unresponsive, not breathing and did not have a pulse. My mother immediately called 911 and my aunt began CPR. When EMS arrived he was found to be in cardiac arrest and after 25 min of efforts by EMS my father passed away less than 24 hours after receiving his 2nd covid vaccine."
	"1188519-1"	"1188519-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"On 3/29/21 at 11:00pm my dad began having chills and uncontrollable shaking. My mother contacted Pfizer who instructed us to alternate Tylenol and Motrin. Tylenol given and Motrin given 4 hours later as instructed by Pfizer. On 3/30/21 around 11:10am my dad was found unresponsive, not breathing and did not have a pulse. My mother immediately called 911 and my aunt began CPR. When EMS arrived he was found to be in cardiac arrest and after 25 min of efforts by EMS my father passed away less than 24 hours after receiving his 2nd covid vaccine."
	"1188519-1"	"1188519-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"On 3/29/21 at 11:00pm my dad began having chills and uncontrollable shaking. My mother contacted Pfizer who instructed us to alternate Tylenol and Motrin. Tylenol given and Motrin given 4 hours later as instructed by Pfizer. On 3/30/21 around 11:10am my dad was found unresponsive, not breathing and did not have a pulse. My mother immediately called 911 and my aunt began CPR. When EMS arrived he was found to be in cardiac arrest and after 25 min of efforts by EMS my father passed away less than 24 hours after receiving his 2nd covid vaccine."
	"1188519-1"	"1188519-1"	"PULSE ABSENT"	"10037469"	"65-79 years"	"65-79"	"On 3/29/21 at 11:00pm my dad began having chills and uncontrollable shaking. My mother contacted Pfizer who instructed us to alternate Tylenol and Motrin. Tylenol given and Motrin given 4 hours later as instructed by Pfizer. On 3/30/21 around 11:10am my dad was found unresponsive, not breathing and did not have a pulse. My mother immediately called 911 and my aunt began CPR. When EMS arrived he was found to be in cardiac arrest and after 25 min of efforts by EMS my father passed away less than 24 hours after receiving his 2nd covid vaccine."
	"1188519-1"	"1188519-1"	"RESPIRATORY ARREST"	"10038669"	"65-79 years"	"65-79"	"On 3/29/21 at 11:00pm my dad began having chills and uncontrollable shaking. My mother contacted Pfizer who instructed us to alternate Tylenol and Motrin. Tylenol given and Motrin given 4 hours later as instructed by Pfizer. On 3/30/21 around 11:10am my dad was found unresponsive, not breathing and did not have a pulse. My mother immediately called 911 and my aunt began CPR. When EMS arrived he was found to be in cardiac arrest and after 25 min of efforts by EMS my father passed away less than 24 hours after receiving his 2nd covid vaccine."
	"1188519-1"	"1188519-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"On 3/29/21 at 11:00pm my dad began having chills and uncontrollable shaking. My mother contacted Pfizer who instructed us to alternate Tylenol and Motrin. Tylenol given and Motrin given 4 hours later as instructed by Pfizer. On 3/30/21 around 11:10am my dad was found unresponsive, not breathing and did not have a pulse. My mother immediately called 911 and my aunt began CPR. When EMS arrived he was found to be in cardiac arrest and after 25 min of efforts by EMS my father passed away less than 24 hours after receiving his 2nd covid vaccine."
	"1188519-1"	"1188519-1"	"TREMOR"	"10044565"	"65-79 years"	"65-79"	"On 3/29/21 at 11:00pm my dad began having chills and uncontrollable shaking. My mother contacted Pfizer who instructed us to alternate Tylenol and Motrin. Tylenol given and Motrin given 4 hours later as instructed by Pfizer. On 3/30/21 around 11:10am my dad was found unresponsive, not breathing and did not have a pulse. My mother immediately called 911 and my aunt began CPR. When EMS arrived he was found to be in cardiac arrest and after 25 min of efforts by EMS my father passed away less than 24 hours after receiving his 2nd covid vaccine."
	"1188519-1"	"1188519-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"On 3/29/21 at 11:00pm my dad began having chills and uncontrollable shaking. My mother contacted Pfizer who instructed us to alternate Tylenol and Motrin. Tylenol given and Motrin given 4 hours later as instructed by Pfizer. On 3/30/21 around 11:10am my dad was found unresponsive, not breathing and did not have a pulse. My mother immediately called 911 and my aunt began CPR. When EMS arrived he was found to be in cardiac arrest and after 25 min of efforts by EMS my father passed away less than 24 hours after receiving his 2nd covid vaccine."
	"1195054-1"	"1195054-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Received 1st Pfizer vaccine on 3/06/2021 since receiving shot she slept up to 12 hours a day. passed away 9 days after  receiving vaccination.  She had no pre existing conditions."
	"1195054-1"	"1195054-1"	"HYPERSOMNIA"	"10020765"	"65-79 years"	"65-79"	"Received 1st Pfizer vaccine on 3/06/2021 since receiving shot she slept up to 12 hours a day. passed away 9 days after  receiving vaccination.  She had no pre existing conditions."
	"1201130-1"	"1201130-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Death on 03/25/2021 ruled as cardiac arrest."
	"1201130-1"	"1201130-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death on 03/25/2021 ruled as cardiac arrest."
	"1203542-1"	"1203542-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"ACUTE PULMONARY OEDEMA"	"10001029"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"CARDIAC FAILURE ACUTE"	"10007556"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"CEREBROVASCULAR ACCIDENT"	"10008190"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"CHEST X-RAY NORMAL"	"10008500"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"CHRONIC KIDNEY DISEASE"	"10064848"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"COMPUTERISED TOMOGRAM ABNORMAL"	"10010235"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"COMPUTERISED TOMOGRAM HEAD"	"10054003"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"COMPUTERISED TOMOGRAM THORAX"	"10053875"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"FIBRIN D DIMER INCREASED"	"10016581"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"HEMIPARESIS"	"10019465"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"HYPERCOAGULATION"	"10020608"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"MAGNETIC RESONANCE IMAGING HEAD"	"10085255"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"RESPIRATORY FAILURE"	"10038695"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1203542-1"	"1203542-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Unknown if pt had s/s at time of vaccination  on 1/29/2021 and 2/19/2021. From 3/1/2021-3/6/2021, pt hospitalized w/ covid, resp insufficiency, acute on chronic diastolic HF, dyspnea, ele. D-dimer, acute pulm edema and acute on chronic renal insufficiency. Dcd to home. Six hrs later, readmitted w/ worsening multifocal airspace opacities, enlarged cardiac silhouette, sob, cough. No PE on CXR. Recd O2, cefepime, remdesivir, vanco, Lasix, heparin, rivaroxaban, dexamethasone, tocilizumab. On 3/8/2021, pt had onset R weakness, CT w/ distal R MZ occlusion, Intubated for decline. Not TPA candidate. Per neuro, CVA r/t either a fib hx or hypercoagulability r/t covid. Pt died."
	"1204429-1"	"1204429-1"	"BLOOD TEST"	"10061726"	"65-79 years"	"65-79"	"From golfing on 02/23/2021 to dimentia suddenly going into overdrive and death on 03/31/2021 All tests and care was taken to  understand rapid/ unexplained decline."
	"1204429-1"	"1204429-1"	"COMPUTERISED TOMOGRAM HEAD"	"10054003"	"65-79 years"	"65-79"	"From golfing on 02/23/2021 to dimentia suddenly going into overdrive and death on 03/31/2021 All tests and care was taken to  understand rapid/ unexplained decline."
	"1204429-1"	"1204429-1"	"COMPUTERISED TOMOGRAM KIDNEY"	"10054004"	"65-79 years"	"65-79"	"From golfing on 02/23/2021 to dimentia suddenly going into overdrive and death on 03/31/2021 All tests and care was taken to  understand rapid/ unexplained decline."
	"1204429-1"	"1204429-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"From golfing on 02/23/2021 to dimentia suddenly going into overdrive and death on 03/31/2021 All tests and care was taken to  understand rapid/ unexplained decline."
	"1204429-1"	"1204429-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"From golfing on 02/23/2021 to dimentia suddenly going into overdrive and death on 03/31/2021 All tests and care was taken to  understand rapid/ unexplained decline."
	"1204429-1"	"1204429-1"	"DEMENTIA"	"10012267"	"65-79 years"	"65-79"	"From golfing on 02/23/2021 to dimentia suddenly going into overdrive and death on 03/31/2021 All tests and care was taken to  understand rapid/ unexplained decline."
	"1204429-1"	"1204429-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"From golfing on 02/23/2021 to dimentia suddenly going into overdrive and death on 03/31/2021 All tests and care was taken to  understand rapid/ unexplained decline."
	"1204429-1"	"1204429-1"	"URINE ANALYSIS"	"10046614"	"65-79 years"	"65-79"	"From golfing on 02/23/2021 to dimentia suddenly going into overdrive and death on 03/31/2021 All tests and care was taken to  understand rapid/ unexplained decline."
	"1205036-1"	"1205036-1"	"ANTICOAGULANT THERAPY"	"10053468"	"65-79 years"	"65-79"	"On March 30th started with headaches then progressed to shortness of breath while moving. Then on April 4th transport to hospital via EMT  was tested for Covid 19 results was negative. It was determined that blood clots where found in Right leg & Left leg and both lungs and now blood clot was found in heart.  PT has low platelets, low blood pressure.  While in the hospital pt was given herapin . Patient has remained in ICU since the 4th to present time."
	"1205036-1"	"1205036-1"	"BIOPSY BONE MARROW"	"10004737"	"65-79 years"	"65-79"	"On March 30th started with headaches then progressed to shortness of breath while moving. Then on April 4th transport to hospital via EMT  was tested for Covid 19 results was negative. It was determined that blood clots where found in Right leg & Left leg and both lungs and now blood clot was found in heart.  PT has low platelets, low blood pressure.  While in the hospital pt was given herapin . Patient has remained in ICU since the 4th to present time."
	"1205036-1"	"1205036-1"	"BLOOD TEST"	"10061726"	"65-79 years"	"65-79"	"On March 30th started with headaches then progressed to shortness of breath while moving. Then on April 4th transport to hospital via EMT  was tested for Covid 19 results was negative. It was determined that blood clots where found in Right leg & Left leg and both lungs and now blood clot was found in heart.  PT has low platelets, low blood pressure.  While in the hospital pt was given herapin . Patient has remained in ICU since the 4th to present time."
	"1205036-1"	"1205036-1"	"DYSPNOEA EXERTIONAL"	"10013971"	"65-79 years"	"65-79"	"On March 30th started with headaches then progressed to shortness of breath while moving. Then on April 4th transport to hospital via EMT  was tested for Covid 19 results was negative. It was determined that blood clots where found in Right leg & Left leg and both lungs and now blood clot was found in heart.  PT has low platelets, low blood pressure.  While in the hospital pt was given herapin . Patient has remained in ICU since the 4th to present time."
	"1205036-1"	"1205036-1"	"ELECTROCARDIOGRAM"	"10014362"	"65-79 years"	"65-79"	"On March 30th started with headaches then progressed to shortness of breath while moving. Then on April 4th transport to hospital via EMT  was tested for Covid 19 results was negative. It was determined that blood clots where found in Right leg & Left leg and both lungs and now blood clot was found in heart.  PT has low platelets, low blood pressure.  While in the hospital pt was given herapin . Patient has remained in ICU since the 4th to present time."
	"1205036-1"	"1205036-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	"On March 30th started with headaches then progressed to shortness of breath while moving. Then on April 4th transport to hospital via EMT  was tested for Covid 19 results was negative. It was determined that blood clots where found in Right leg & Left leg and both lungs and now blood clot was found in heart.  PT has low platelets, low blood pressure.  While in the hospital pt was given herapin . Patient has remained in ICU since the 4th to present time."
	"1205036-1"	"1205036-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	"On March 30th started with headaches then progressed to shortness of breath while moving. Then on April 4th transport to hospital via EMT  was tested for Covid 19 results was negative. It was determined that blood clots where found in Right leg & Left leg and both lungs and now blood clot was found in heart.  PT has low platelets, low blood pressure.  While in the hospital pt was given herapin . Patient has remained in ICU since the 4th to present time."
	"1205036-1"	"1205036-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"On March 30th started with headaches then progressed to shortness of breath while moving. Then on April 4th transport to hospital via EMT  was tested for Covid 19 results was negative. It was determined that blood clots where found in Right leg & Left leg and both lungs and now blood clot was found in heart.  PT has low platelets, low blood pressure.  While in the hospital pt was given herapin . Patient has remained in ICU since the 4th to present time."
	"1205036-1"	"1205036-1"	"INTRACARDIAC THROMBUS"	"10048620"	"65-79 years"	"65-79"	"On March 30th started with headaches then progressed to shortness of breath while moving. Then on April 4th transport to hospital via EMT  was tested for Covid 19 results was negative. It was determined that blood clots where found in Right leg & Left leg and both lungs and now blood clot was found in heart.  PT has low platelets, low blood pressure.  While in the hospital pt was given herapin . Patient has remained in ICU since the 4th to present time."
	"1205036-1"	"1205036-1"	"PLATELET COUNT DECREASED"	"10035528"	"65-79 years"	"65-79"	"On March 30th started with headaches then progressed to shortness of breath while moving. Then on April 4th transport to hospital via EMT  was tested for Covid 19 results was negative. It was determined that blood clots where found in Right leg & Left leg and both lungs and now blood clot was found in heart.  PT has low platelets, low blood pressure.  While in the hospital pt was given herapin . Patient has remained in ICU since the 4th to present time."
	"1205036-1"	"1205036-1"	"PULMONARY EMBOLISM"	"10037377"	"65-79 years"	"65-79"	"On March 30th started with headaches then progressed to shortness of breath while moving. Then on April 4th transport to hospital via EMT  was tested for Covid 19 results was negative. It was determined that blood clots where found in Right leg & Left leg and both lungs and now blood clot was found in heart.  PT has low platelets, low blood pressure.  While in the hospital pt was given herapin . Patient has remained in ICU since the 4th to present time."
	"1205036-1"	"1205036-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	"On March 30th started with headaches then progressed to shortness of breath while moving. Then on April 4th transport to hospital via EMT  was tested for Covid 19 results was negative. It was determined that blood clots where found in Right leg & Left leg and both lungs and now blood clot was found in heart.  PT has low platelets, low blood pressure.  While in the hospital pt was given herapin . Patient has remained in ICU since the 4th to present time."
	"1205036-1"	"1205036-1"	"THROMBOSIS"	"10043607"	"65-79 years"	"65-79"	"On March 30th started with headaches then progressed to shortness of breath while moving. Then on April 4th transport to hospital via EMT  was tested for Covid 19 results was negative. It was determined that blood clots where found in Right leg & Left leg and both lungs and now blood clot was found in heart.  PT has low platelets, low blood pressure.  While in the hospital pt was given herapin . Patient has remained in ICU since the 4th to present time."
	"1207687-1"	"1207687-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"My husband became very sick the day after recieving the shot. He was freezing cold. No matter what he did he could not get warm. He experienced flu like symptons for about 24 hours. This was on Saturday. On Tuesday he died. They said it was a heart attack. He was in excellent health. We had gone to the gym 3 days a week for years. He was doing Cardio on the bike and treadmill for over an hour each time. He never experienced shortness of breath and before the shot was 100 % healthy"
	"1207687-1"	"1207687-1"	"FEELING COLD"	"10016326"	"65-79 years"	"65-79"	"My husband became very sick the day after recieving the shot. He was freezing cold. No matter what he did he could not get warm. He experienced flu like symptons for about 24 hours. This was on Saturday. On Tuesday he died. They said it was a heart attack. He was in excellent health. We had gone to the gym 3 days a week for years. He was doing Cardio on the bike and treadmill for over an hour each time. He never experienced shortness of breath and before the shot was 100 % healthy"
	"1207687-1"	"1207687-1"	"ILLNESS"	"10080284"	"65-79 years"	"65-79"	"My husband became very sick the day after recieving the shot. He was freezing cold. No matter what he did he could not get warm. He experienced flu like symptons for about 24 hours. This was on Saturday. On Tuesday he died. They said it was a heart attack. He was in excellent health. We had gone to the gym 3 days a week for years. He was doing Cardio on the bike and treadmill for over an hour each time. He never experienced shortness of breath and before the shot was 100 % healthy"
	"1207687-1"	"1207687-1"	"INFLUENZA LIKE ILLNESS"	"10022004"	"65-79 years"	"65-79"	"My husband became very sick the day after recieving the shot. He was freezing cold. No matter what he did he could not get warm. He experienced flu like symptons for about 24 hours. This was on Saturday. On Tuesday he died. They said it was a heart attack. He was in excellent health. We had gone to the gym 3 days a week for years. He was doing Cardio on the bike and treadmill for over an hour each time. He never experienced shortness of breath and before the shot was 100 % healthy"
	"1207687-1"	"1207687-1"	"MYOCARDIAL INFARCTION"	"10028596"	"65-79 years"	"65-79"	"My husband became very sick the day after recieving the shot. He was freezing cold. No matter what he did he could not get warm. He experienced flu like symptons for about 24 hours. This was on Saturday. On Tuesday he died. They said it was a heart attack. He was in excellent health. We had gone to the gym 3 days a week for years. He was doing Cardio on the bike and treadmill for over an hour each time. He never experienced shortness of breath and before the shot was 100 % healthy"
	"1207989-1"	"1207989-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"The decedent was last seen alive at approximately 0130 when the decedent's next of kin (NOK) heard the decedent walking around the residence. The decedent complained of arm soreness and indigestion; the decedent received a second COVID-19 vaccination (Moderna) on 04/12/2021. The decedent went to the living room to sleep on the couch due to the health and soreness complaints. At approximately 0750, NOK entered the living room and found the decedent unconscious and not breathing."
	"1207989-1"	"1207989-1"	"DYSPEPSIA"	"10013946"	"65-79 years"	"65-79"	"The decedent was last seen alive at approximately 0130 when the decedent's next of kin (NOK) heard the decedent walking around the residence. The decedent complained of arm soreness and indigestion; the decedent received a second COVID-19 vaccination (Moderna) on 04/12/2021. The decedent went to the living room to sleep on the couch due to the health and soreness complaints. At approximately 0750, NOK entered the living room and found the decedent unconscious and not breathing."
	"1207989-1"	"1207989-1"	"LOSS OF CONSCIOUSNESS"	"10024855"	"65-79 years"	"65-79"	"The decedent was last seen alive at approximately 0130 when the decedent's next of kin (NOK) heard the decedent walking around the residence. The decedent complained of arm soreness and indigestion; the decedent received a second COVID-19 vaccination (Moderna) on 04/12/2021. The decedent went to the living room to sleep on the couch due to the health and soreness complaints. At approximately 0750, NOK entered the living room and found the decedent unconscious and not breathing."
	"1207989-1"	"1207989-1"	"PAIN IN EXTREMITY"	"10033425"	"65-79 years"	"65-79"	"The decedent was last seen alive at approximately 0130 when the decedent's next of kin (NOK) heard the decedent walking around the residence. The decedent complained of arm soreness and indigestion; the decedent received a second COVID-19 vaccination (Moderna) on 04/12/2021. The decedent went to the living room to sleep on the couch due to the health and soreness complaints. At approximately 0750, NOK entered the living room and found the decedent unconscious and not breathing."
	"1207989-1"	"1207989-1"	"RESPIRATORY ARREST"	"10038669"	"65-79 years"	"65-79"	"The decedent was last seen alive at approximately 0130 when the decedent's next of kin (NOK) heard the decedent walking around the residence. The decedent complained of arm soreness and indigestion; the decedent received a second COVID-19 vaccination (Moderna) on 04/12/2021. The decedent went to the living room to sleep on the couch due to the health and soreness complaints. At approximately 0750, NOK entered the living room and found the decedent unconscious and not breathing."
	"1209724-1"	"1209724-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Hospice patient received Janssen vaccine on Friday and passed away peacefully on Monday.  We don't think the death is related to the vaccine but reporting it since it happened less than a week after receiving vaccine"
	"1209804-1"	"1209804-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Timeline of events:     o       No concerns in the past month.  o       Usual state of health on Friday 4/9/2021  o       Received Pfizer vaccine at event on 4/9/2021  o       Fatigue, poor PO intake and myalgia on Saturday, 4/10/2021; Received Tylenol at 1 pm  o       Texted Primary Community Nurse (PCN) (not on call), on Saturday, to share above. PCN followed up Sunday morning and reassured them.  o       Last seen alive Sunday night, not well from vaccine but does not seem like family was concerned enough to page on call team  o       Monday morning- found dead in rigor mortis  o       Cause of death: deemed sudden cardiac death. Etiology unclear.  o       Unexpected death."
	"1209804-1"	"1209804-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"Timeline of events:     o       No concerns in the past month.  o       Usual state of health on Friday 4/9/2021  o       Received Pfizer vaccine at event on 4/9/2021  o       Fatigue, poor PO intake and myalgia on Saturday, 4/10/2021; Received Tylenol at 1 pm  o       Texted Primary Community Nurse (PCN) (not on call), on Saturday, to share above. PCN followed up Sunday morning and reassured them.  o       Last seen alive Sunday night, not well from vaccine but does not seem like family was concerned enough to page on call team  o       Monday morning- found dead in rigor mortis  o       Cause of death: deemed sudden cardiac death. Etiology unclear.  o       Unexpected death."
	"1209804-1"	"1209804-1"	"HYPOPHAGIA"	"10063743"	"65-79 years"	"65-79"	"Timeline of events:     o       No concerns in the past month.  o       Usual state of health on Friday 4/9/2021  o       Received Pfizer vaccine at event on 4/9/2021  o       Fatigue, poor PO intake and myalgia on Saturday, 4/10/2021; Received Tylenol at 1 pm  o       Texted Primary Community Nurse (PCN) (not on call), on Saturday, to share above. PCN followed up Sunday morning and reassured them.  o       Last seen alive Sunday night, not well from vaccine but does not seem like family was concerned enough to page on call team  o       Monday morning- found dead in rigor mortis  o       Cause of death: deemed sudden cardiac death. Etiology unclear.  o       Unexpected death."
	"1209804-1"	"1209804-1"	"MYALGIA"	"10028411"	"65-79 years"	"65-79"	"Timeline of events:     o       No concerns in the past month.  o       Usual state of health on Friday 4/9/2021  o       Received Pfizer vaccine at event on 4/9/2021  o       Fatigue, poor PO intake and myalgia on Saturday, 4/10/2021; Received Tylenol at 1 pm  o       Texted Primary Community Nurse (PCN) (not on call), on Saturday, to share above. PCN followed up Sunday morning and reassured them.  o       Last seen alive Sunday night, not well from vaccine but does not seem like family was concerned enough to page on call team  o       Monday morning- found dead in rigor mortis  o       Cause of death: deemed sudden cardiac death. Etiology unclear.  o       Unexpected death."
	"1209804-1"	"1209804-1"	"SUDDEN CARDIAC DEATH"	"10049418"	"65-79 years"	"65-79"	"Timeline of events:     o       No concerns in the past month.  o       Usual state of health on Friday 4/9/2021  o       Received Pfizer vaccine at event on 4/9/2021  o       Fatigue, poor PO intake and myalgia on Saturday, 4/10/2021; Received Tylenol at 1 pm  o       Texted Primary Community Nurse (PCN) (not on call), on Saturday, to share above. PCN followed up Sunday morning and reassured them.  o       Last seen alive Sunday night, not well from vaccine but does not seem like family was concerned enough to page on call team  o       Monday morning- found dead in rigor mortis  o       Cause of death: deemed sudden cardiac death. Etiology unclear.  o       Unexpected death."
	"1210441-1"	"1210441-1"	"ANXIETY"	"10002855"	"65-79 years"	"65-79"	"I spoke to patient by phone on Saturday morning around 9:20am. He was concerned about the fatigue, nausea, headache, chills, and muscle aches he had the night before. He felt better when I spoke to him. He wanted to know when those side effects would go away finally. Since I had the Moderna vaccine I said 24 to 36 hours. But I didn't know about the J&J vaccine. We disconnect the call at 9:40am Saturday morning. After the call at some point he fixed lunch or dinner and stopped eating before finishing his meal. He had left the food on the table and in the pans he fixed it in. Very unusual for him.  The patient then went to his room where is was found Monday 3/22/21 around noon in his bed laying on his chest (he hated to lie on his chest) by the police and the HR officer from his work.   The HR officer had called my other brother around 11:15am on 3/22 /21 to ask if we had heard from the patient because he had not reported to work or phoned in. He has passed sometime between noon on Saturday till Sunday evening alone at his residence. He had towels and a trash can beside his bed when he was found.  The coroner call it death by natural causes and would not do an autopsy when even asked by his PCP."
	"1210441-1"	"1210441-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"I spoke to patient by phone on Saturday morning around 9:20am. He was concerned about the fatigue, nausea, headache, chills, and muscle aches he had the night before. He felt better when I spoke to him. He wanted to know when those side effects would go away finally. Since I had the Moderna vaccine I said 24 to 36 hours. But I didn't know about the J&J vaccine. We disconnect the call at 9:40am Saturday morning. After the call at some point he fixed lunch or dinner and stopped eating before finishing his meal. He had left the food on the table and in the pans he fixed it in. Very unusual for him.  The patient then went to his room where is was found Monday 3/22/21 around noon in his bed laying on his chest (he hated to lie on his chest) by the police and the HR officer from his work.   The HR officer had called my other brother around 11:15am on 3/22 /21 to ask if we had heard from the patient because he had not reported to work or phoned in. He has passed sometime between noon on Saturday till Sunday evening alone at his residence. He had towels and a trash can beside his bed when he was found.  The coroner call it death by natural causes and would not do an autopsy when even asked by his PCP."
	"1210441-1"	"1210441-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"I spoke to patient by phone on Saturday morning around 9:20am. He was concerned about the fatigue, nausea, headache, chills, and muscle aches he had the night before. He felt better when I spoke to him. He wanted to know when those side effects would go away finally. Since I had the Moderna vaccine I said 24 to 36 hours. But I didn't know about the J&J vaccine. We disconnect the call at 9:40am Saturday morning. After the call at some point he fixed lunch or dinner and stopped eating before finishing his meal. He had left the food on the table and in the pans he fixed it in. Very unusual for him.  The patient then went to his room where is was found Monday 3/22/21 around noon in his bed laying on his chest (he hated to lie on his chest) by the police and the HR officer from his work.   The HR officer had called my other brother around 11:15am on 3/22 /21 to ask if we had heard from the patient because he had not reported to work or phoned in. He has passed sometime between noon on Saturday till Sunday evening alone at his residence. He had towels and a trash can beside his bed when he was found.  The coroner call it death by natural causes and would not do an autopsy when even asked by his PCP."
	"1210441-1"	"1210441-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"I spoke to patient by phone on Saturday morning around 9:20am. He was concerned about the fatigue, nausea, headache, chills, and muscle aches he had the night before. He felt better when I spoke to him. He wanted to know when those side effects would go away finally. Since I had the Moderna vaccine I said 24 to 36 hours. But I didn't know about the J&J vaccine. We disconnect the call at 9:40am Saturday morning. After the call at some point he fixed lunch or dinner and stopped eating before finishing his meal. He had left the food on the table and in the pans he fixed it in. Very unusual for him.  The patient then went to his room where is was found Monday 3/22/21 around noon in his bed laying on his chest (he hated to lie on his chest) by the police and the HR officer from his work.   The HR officer had called my other brother around 11:15am on 3/22 /21 to ask if we had heard from the patient because he had not reported to work or phoned in. He has passed sometime between noon on Saturday till Sunday evening alone at his residence. He had towels and a trash can beside his bed when he was found.  The coroner call it death by natural causes and would not do an autopsy when even asked by his PCP."
	"1210441-1"	"1210441-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	"I spoke to patient by phone on Saturday morning around 9:20am. He was concerned about the fatigue, nausea, headache, chills, and muscle aches he had the night before. He felt better when I spoke to him. He wanted to know when those side effects would go away finally. Since I had the Moderna vaccine I said 24 to 36 hours. But I didn't know about the J&J vaccine. We disconnect the call at 9:40am Saturday morning. After the call at some point he fixed lunch or dinner and stopped eating before finishing his meal. He had left the food on the table and in the pans he fixed it in. Very unusual for him.  The patient then went to his room where is was found Monday 3/22/21 around noon in his bed laying on his chest (he hated to lie on his chest) by the police and the HR officer from his work.   The HR officer had called my other brother around 11:15am on 3/22 /21 to ask if we had heard from the patient because he had not reported to work or phoned in. He has passed sometime between noon on Saturday till Sunday evening alone at his residence. He had towels and a trash can beside his bed when he was found.  The coroner call it death by natural causes and would not do an autopsy when even asked by his PCP."
	"1210441-1"	"1210441-1"	"MYALGIA"	"10028411"	"65-79 years"	"65-79"	"I spoke to patient by phone on Saturday morning around 9:20am. He was concerned about the fatigue, nausea, headache, chills, and muscle aches he had the night before. He felt better when I spoke to him. He wanted to know when those side effects would go away finally. Since I had the Moderna vaccine I said 24 to 36 hours. But I didn't know about the J&J vaccine. We disconnect the call at 9:40am Saturday morning. After the call at some point he fixed lunch or dinner and stopped eating before finishing his meal. He had left the food on the table and in the pans he fixed it in. Very unusual for him.  The patient then went to his room where is was found Monday 3/22/21 around noon in his bed laying on his chest (he hated to lie on his chest) by the police and the HR officer from his work.   The HR officer had called my other brother around 11:15am on 3/22 /21 to ask if we had heard from the patient because he had not reported to work or phoned in. He has passed sometime between noon on Saturday till Sunday evening alone at his residence. He had towels and a trash can beside his bed when he was found.  The coroner call it death by natural causes and would not do an autopsy when even asked by his PCP."
	"1210441-1"	"1210441-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"I spoke to patient by phone on Saturday morning around 9:20am. He was concerned about the fatigue, nausea, headache, chills, and muscle aches he had the night before. He felt better when I spoke to him. He wanted to know when those side effects would go away finally. Since I had the Moderna vaccine I said 24 to 36 hours. But I didn't know about the J&J vaccine. We disconnect the call at 9:40am Saturday morning. After the call at some point he fixed lunch or dinner and stopped eating before finishing his meal. He had left the food on the table and in the pans he fixed it in. Very unusual for him.  The patient then went to his room where is was found Monday 3/22/21 around noon in his bed laying on his chest (he hated to lie on his chest) by the police and the HR officer from his work.   The HR officer had called my other brother around 11:15am on 3/22 /21 to ask if we had heard from the patient because he had not reported to work or phoned in. He has passed sometime between noon on Saturday till Sunday evening alone at his residence. He had towels and a trash can beside his bed when he was found.  The coroner call it death by natural causes and would not do an autopsy when even asked by his PCP."
	"1211110-1"	"1211110-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Death"
	"1211110-1"	"1211110-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death"
	"1213047-1"	"1213047-1"	"AGEUSIA"	"10001480"	"65-79 years"	"65-79"	"This is the patient's spouse reporting.  The day following the vaccination, wife began to suffer mild, common vaccination symptoms such as fatigue, hills, and joint pain.  In the days following, in addition to those symptoms, she began to cough and had a sore throat.  By March 8th, she had lost her sense of taste and sense of smell. We realized we needed to have her tested for COVID-19. We went to a testing area. She was seen and tested. She tested positive for COVID-19 (as did I).  The belief was that our illness was uncomplicated and we were sent home with instructions to monitor our symptoms.  On 03/14/2021, I took her to the hospital because her condition was worsening."
	"1213047-1"	"1213047-1"	"ANOSMIA"	"10002653"	"65-79 years"	"65-79"	"This is the patient's spouse reporting.  The day following the vaccination, wife began to suffer mild, common vaccination symptoms such as fatigue, hills, and joint pain.  In the days following, in addition to those symptoms, she began to cough and had a sore throat.  By March 8th, she had lost her sense of taste and sense of smell. We realized we needed to have her tested for COVID-19. We went to a testing area. She was seen and tested. She tested positive for COVID-19 (as did I).  The belief was that our illness was uncomplicated and we were sent home with instructions to monitor our symptoms.  On 03/14/2021, I took her to the hospital because her condition was worsening."
	"1213047-1"	"1213047-1"	"ARTHRALGIA"	"10003239"	"65-79 years"	"65-79"	"This is the patient's spouse reporting.  The day following the vaccination, wife began to suffer mild, common vaccination symptoms such as fatigue, hills, and joint pain.  In the days following, in addition to those symptoms, she began to cough and had a sore throat.  By March 8th, she had lost her sense of taste and sense of smell. We realized we needed to have her tested for COVID-19. We went to a testing area. She was seen and tested. She tested positive for COVID-19 (as did I).  The belief was that our illness was uncomplicated and we were sent home with instructions to monitor our symptoms.  On 03/14/2021, I took her to the hospital because her condition was worsening."
	"1213047-1"	"1213047-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"This is the patient's spouse reporting.  The day following the vaccination, wife began to suffer mild, common vaccination symptoms such as fatigue, hills, and joint pain.  In the days following, in addition to those symptoms, she began to cough and had a sore throat.  By March 8th, she had lost her sense of taste and sense of smell. We realized we needed to have her tested for COVID-19. We went to a testing area. She was seen and tested. She tested positive for COVID-19 (as did I).  The belief was that our illness was uncomplicated and we were sent home with instructions to monitor our symptoms.  On 03/14/2021, I took her to the hospital because her condition was worsening."
	"1213047-1"	"1213047-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"This is the patient's spouse reporting.  The day following the vaccination, wife began to suffer mild, common vaccination symptoms such as fatigue, hills, and joint pain.  In the days following, in addition to those symptoms, she began to cough and had a sore throat.  By March 8th, she had lost her sense of taste and sense of smell. We realized we needed to have her tested for COVID-19. We went to a testing area. She was seen and tested. She tested positive for COVID-19 (as did I).  The belief was that our illness was uncomplicated and we were sent home with instructions to monitor our symptoms.  On 03/14/2021, I took her to the hospital because her condition was worsening."
	"1213047-1"	"1213047-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"This is the patient's spouse reporting.  The day following the vaccination, wife began to suffer mild, common vaccination symptoms such as fatigue, hills, and joint pain.  In the days following, in addition to those symptoms, she began to cough and had a sore throat.  By March 8th, she had lost her sense of taste and sense of smell. We realized we needed to have her tested for COVID-19. We went to a testing area. She was seen and tested. She tested positive for COVID-19 (as did I).  The belief was that our illness was uncomplicated and we were sent home with instructions to monitor our symptoms.  On 03/14/2021, I took her to the hospital because her condition was worsening."
	"1213047-1"	"1213047-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"This is the patient's spouse reporting.  The day following the vaccination, wife began to suffer mild, common vaccination symptoms such as fatigue, hills, and joint pain.  In the days following, in addition to those symptoms, she began to cough and had a sore throat.  By March 8th, she had lost her sense of taste and sense of smell. We realized we needed to have her tested for COVID-19. We went to a testing area. She was seen and tested. She tested positive for COVID-19 (as did I).  The belief was that our illness was uncomplicated and we were sent home with instructions to monitor our symptoms.  On 03/14/2021, I took her to the hospital because her condition was worsening."
	"1213047-1"	"1213047-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"This is the patient's spouse reporting.  The day following the vaccination, wife began to suffer mild, common vaccination symptoms such as fatigue, hills, and joint pain.  In the days following, in addition to those symptoms, she began to cough and had a sore throat.  By March 8th, she had lost her sense of taste and sense of smell. We realized we needed to have her tested for COVID-19. We went to a testing area. She was seen and tested. She tested positive for COVID-19 (as did I).  The belief was that our illness was uncomplicated and we were sent home with instructions to monitor our symptoms.  On 03/14/2021, I took her to the hospital because her condition was worsening."
	"1213047-1"	"1213047-1"	"OROPHARYNGEAL PAIN"	"10068319"	"65-79 years"	"65-79"	"This is the patient's spouse reporting.  The day following the vaccination, wife began to suffer mild, common vaccination symptoms such as fatigue, hills, and joint pain.  In the days following, in addition to those symptoms, she began to cough and had a sore throat.  By March 8th, she had lost her sense of taste and sense of smell. We realized we needed to have her tested for COVID-19. We went to a testing area. She was seen and tested. She tested positive for COVID-19 (as did I).  The belief was that our illness was uncomplicated and we were sent home with instructions to monitor our symptoms.  On 03/14/2021, I took her to the hospital because her condition was worsening."
	"1213047-1"	"1213047-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"This is the patient's spouse reporting.  The day following the vaccination, wife began to suffer mild, common vaccination symptoms such as fatigue, hills, and joint pain.  In the days following, in addition to those symptoms, she began to cough and had a sore throat.  By March 8th, she had lost her sense of taste and sense of smell. We realized we needed to have her tested for COVID-19. We went to a testing area. She was seen and tested. She tested positive for COVID-19 (as did I).  The belief was that our illness was uncomplicated and we were sent home with instructions to monitor our symptoms.  On 03/14/2021, I took her to the hospital because her condition was worsening."
	"1214139-1"	"1214139-1"	"ACUTE CARDIAC EVENT"	"10081099"	"65-79 years"	"65-79"	"Cardiac Event"
	"1214139-1"	"1214139-1"	"BLOOD GLUCOSE NORMAL"	"10005558"	"65-79 years"	"65-79"	"Cardiac Event"
	"1220532-1"	"1220532-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"On 4/16/2021 I received a phone call from public health informing us that the patient died on 3/31/2021."
	"1228594-1"	"1228594-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Contacted Veteran's son.  He did mention that his father was not healthy, but also that his father did not voice any specific changes to his health as recently as Tuesday (4/13) when they last spoke after receiving his second dose of vaccine on 4/10.  He did mention that the coroner had declared his father?s death ?natural? and was not planning to do an autopsy."
	"1237104-1"	"1237104-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt received vaccine on 4/20/21 at 1:00pm, observed 30 mins post injection with no adverse reaction noted. Pt collapsed at home early morning on 4/21 & transported to ED via ambulance where he later expired."
	"1237104-1"	"1237104-1"	"SYNCOPE"	"10042772"	"65-79 years"	"65-79"	"Pt received vaccine on 4/20/21 at 1:00pm, observed 30 mins post injection with no adverse reaction noted. Pt collapsed at home early morning on 4/21 & transported to ED via ambulance where he later expired."
	"1238185-1"	"1238185-1"	"BLOOD POTASSIUM INCREASED"	"10005725"	"65-79 years"	"65-79"	"Received 2nd COVID vaccine on 4/19/21.  Apparently hadn't been feeling well since.  Presented to the ED on 4/21/21 with hypotension, bradycardia, hypoxia and a GCS of 3.   Does have a history of ESRD on HD, but no missed dialysis sessions. Found to have a potassium of 8.7.  There was concern for pulmonary embolism but was not hemodynamically stable enough to undergo imaging.   Went into PEA arrest x 3 in the ED and ultimately died.  Of note, patient did have a recent ankle fracture recently and apparently has been non-ambulatory for at least the past few days."
	"1238185-1"	"1238185-1"	"BRADYCARDIA"	"10006093"	"65-79 years"	"65-79"	"Received 2nd COVID vaccine on 4/19/21.  Apparently hadn't been feeling well since.  Presented to the ED on 4/21/21 with hypotension, bradycardia, hypoxia and a GCS of 3.   Does have a history of ESRD on HD, but no missed dialysis sessions. Found to have a potassium of 8.7.  There was concern for pulmonary embolism but was not hemodynamically stable enough to undergo imaging.   Went into PEA arrest x 3 in the ED and ultimately died.  Of note, patient did have a recent ankle fracture recently and apparently has been non-ambulatory for at least the past few days."
	"1238185-1"	"1238185-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Received 2nd COVID vaccine on 4/19/21.  Apparently hadn't been feeling well since.  Presented to the ED on 4/21/21 with hypotension, bradycardia, hypoxia and a GCS of 3.   Does have a history of ESRD on HD, but no missed dialysis sessions. Found to have a potassium of 8.7.  There was concern for pulmonary embolism but was not hemodynamically stable enough to undergo imaging.   Went into PEA arrest x 3 in the ED and ultimately died.  Of note, patient did have a recent ankle fracture recently and apparently has been non-ambulatory for at least the past few days."
	"1238185-1"	"1238185-1"	"COMA SCALE ABNORMAL"	"10069709"	"65-79 years"	"65-79"	"Received 2nd COVID vaccine on 4/19/21.  Apparently hadn't been feeling well since.  Presented to the ED on 4/21/21 with hypotension, bradycardia, hypoxia and a GCS of 3.   Does have a history of ESRD on HD, but no missed dialysis sessions. Found to have a potassium of 8.7.  There was concern for pulmonary embolism but was not hemodynamically stable enough to undergo imaging.   Went into PEA arrest x 3 in the ED and ultimately died.  Of note, patient did have a recent ankle fracture recently and apparently has been non-ambulatory for at least the past few days."
	"1238185-1"	"1238185-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Received 2nd COVID vaccine on 4/19/21.  Apparently hadn't been feeling well since.  Presented to the ED on 4/21/21 with hypotension, bradycardia, hypoxia and a GCS of 3.   Does have a history of ESRD on HD, but no missed dialysis sessions. Found to have a potassium of 8.7.  There was concern for pulmonary embolism but was not hemodynamically stable enough to undergo imaging.   Went into PEA arrest x 3 in the ED and ultimately died.  Of note, patient did have a recent ankle fracture recently and apparently has been non-ambulatory for at least the past few days."
	"1238185-1"	"1238185-1"	"HAEMODYNAMIC INSTABILITY"	"10052076"	"65-79 years"	"65-79"	"Received 2nd COVID vaccine on 4/19/21.  Apparently hadn't been feeling well since.  Presented to the ED on 4/21/21 with hypotension, bradycardia, hypoxia and a GCS of 3.   Does have a history of ESRD on HD, but no missed dialysis sessions. Found to have a potassium of 8.7.  There was concern for pulmonary embolism but was not hemodynamically stable enough to undergo imaging.   Went into PEA arrest x 3 in the ED and ultimately died.  Of note, patient did have a recent ankle fracture recently and apparently has been non-ambulatory for at least the past few days."
	"1238185-1"	"1238185-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	"Received 2nd COVID vaccine on 4/19/21.  Apparently hadn't been feeling well since.  Presented to the ED on 4/21/21 with hypotension, bradycardia, hypoxia and a GCS of 3.   Does have a history of ESRD on HD, but no missed dialysis sessions. Found to have a potassium of 8.7.  There was concern for pulmonary embolism but was not hemodynamically stable enough to undergo imaging.   Went into PEA arrest x 3 in the ED and ultimately died.  Of note, patient did have a recent ankle fracture recently and apparently has been non-ambulatory for at least the past few days."
	"1238185-1"	"1238185-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Received 2nd COVID vaccine on 4/19/21.  Apparently hadn't been feeling well since.  Presented to the ED on 4/21/21 with hypotension, bradycardia, hypoxia and a GCS of 3.   Does have a history of ESRD on HD, but no missed dialysis sessions. Found to have a potassium of 8.7.  There was concern for pulmonary embolism but was not hemodynamically stable enough to undergo imaging.   Went into PEA arrest x 3 in the ED and ultimately died.  Of note, patient did have a recent ankle fracture recently and apparently has been non-ambulatory for at least the past few days."
	"1238185-1"	"1238185-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Received 2nd COVID vaccine on 4/19/21.  Apparently hadn't been feeling well since.  Presented to the ED on 4/21/21 with hypotension, bradycardia, hypoxia and a GCS of 3.   Does have a history of ESRD on HD, but no missed dialysis sessions. Found to have a potassium of 8.7.  There was concern for pulmonary embolism but was not hemodynamically stable enough to undergo imaging.   Went into PEA arrest x 3 in the ED and ultimately died.  Of note, patient did have a recent ankle fracture recently and apparently has been non-ambulatory for at least the past few days."
	"1238185-1"	"1238185-1"	"PULSELESS ELECTRICAL ACTIVITY"	"10058151"	"65-79 years"	"65-79"	"Received 2nd COVID vaccine on 4/19/21.  Apparently hadn't been feeling well since.  Presented to the ED on 4/21/21 with hypotension, bradycardia, hypoxia and a GCS of 3.   Does have a history of ESRD on HD, but no missed dialysis sessions. Found to have a potassium of 8.7.  There was concern for pulmonary embolism but was not hemodynamically stable enough to undergo imaging.   Went into PEA arrest x 3 in the ED and ultimately died.  Of note, patient did have a recent ankle fracture recently and apparently has been non-ambulatory for at least the past few days."
	"1245000-1"	"1245000-1"	"COMPUTERISED TOMOGRAM THORAX ABNORMAL"	"10057799"	"65-79 years"	"65-79"	"Blood clots in the lungs, pulmonary embolism"
	"1245000-1"	"1245000-1"	"PULMONARY EMBOLISM"	"10037377"	"65-79 years"	"65-79"	"Blood clots in the lungs, pulmonary embolism"
	"1245000-1"	"1245000-1"	"THROMBOSIS"	"10043607"	"65-79 years"	"65-79"	"Blood clots in the lungs, pulmonary embolism"
	"1246484-1"	"1246484-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received her first Moderna dose on 03/12/21  at 1:24pm in the Right Deltoid, Lot# 036A21A,  no reaction after 15 min. No reaction was reported 15 min. after her second dose which was in the opposite arm. See was being watched by her family members that evening, family members did not report anything at that time. Her temperature on 4/16/21 was 97.1"
	"1247898-1"	"1247898-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient had second covid 19 vaccine on 2/2/21 at pharmacy. Was admitted on 4/6/21 to hospital with Shortness and Breath, Vomiting, and COVID-19 (tested positive on 4/6/21). Patient expired on 4/8/21 @ 1954."
	"1247898-1"	"1247898-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient had second covid 19 vaccine on 2/2/21 at pharmacy. Was admitted on 4/6/21 to hospital with Shortness and Breath, Vomiting, and COVID-19 (tested positive on 4/6/21). Patient expired on 4/8/21 @ 1954."
	"1247898-1"	"1247898-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient had second covid 19 vaccine on 2/2/21 at pharmacy. Was admitted on 4/6/21 to hospital with Shortness and Breath, Vomiting, and COVID-19 (tested positive on 4/6/21). Patient expired on 4/8/21 @ 1954."
	"1247898-1"	"1247898-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient had second covid 19 vaccine on 2/2/21 at pharmacy. Was admitted on 4/6/21 to hospital with Shortness and Breath, Vomiting, and COVID-19 (tested positive on 4/6/21). Patient expired on 4/8/21 @ 1954."
	"1247898-1"	"1247898-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"Patient had second covid 19 vaccine on 2/2/21 at pharmacy. Was admitted on 4/6/21 to hospital with Shortness and Breath, Vomiting, and COVID-19 (tested positive on 4/6/21). Patient expired on 4/8/21 @ 1954."
	"1249581-1"	"1249581-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Died in sleep.  Not sick when he went to bed. Not breathing when found. No sign of puke, blood, urine or BM."
	"1249581-1"	"1249581-1"	"RESPIRATORY ARREST"	"10038669"	"65-79 years"	"65-79"	"Died in sleep.  Not sick when he went to bed. Not breathing when found. No sign of puke, blood, urine or BM."
	"1249581-1"	"1249581-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Died in sleep.  Not sick when he went to bed. Not breathing when found. No sign of puke, blood, urine or BM."
	"1268044-1"	"1268044-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Clinic was informed that patient patient went unresponsive at home at 2pm on 4/21/21 and patient expired."
	"1268044-1"	"1268044-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"Clinic was informed that patient patient went unresponsive at home at 2pm on 4/21/21 and patient expired."
	"1271190-1"	"1271190-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Contracted COVID-19  on 4/4/2021, Pt. demise 4/15/2021"
	"1271190-1"	"1271190-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Contracted COVID-19  on 4/4/2021, Pt. demise 4/15/2021"
	"1271190-1"	"1271190-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Contracted COVID-19  on 4/4/2021, Pt. demise 4/15/2021"
	"1272476-1"	"1272476-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"She was quite sick, dizzy, went to ER three times between Saturday and Sunday, they sent her home each time, she died Monday morning."
	"1272476-1"	"1272476-1"	"DIZZINESS"	"10013573"	"65-79 years"	"65-79"	"She was quite sick, dizzy, went to ER three times between Saturday and Sunday, they sent her home each time, she died Monday morning."
	"1272476-1"	"1272476-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"She was quite sick, dizzy, went to ER three times between Saturday and Sunday, they sent her home each time, she died Monday morning."
	"1272543-1"	"1272543-1"	"ABDOMINAL EXPLORATION"	"10053309"	"65-79 years"	"65-79"	"The following evening after the shot, he had severe pains in his back and shoulders, headache, nausea (vomited). 2 days later, felt severe pain in his stomach, along with pain in his shoulders and back, with a headache, also vomited."
	"1272543-1"	"1272543-1"	"ABDOMINAL PAIN UPPER"	"10000087"	"65-79 years"	"65-79"	"The following evening after the shot, he had severe pains in his back and shoulders, headache, nausea (vomited). 2 days later, felt severe pain in his stomach, along with pain in his shoulders and back, with a headache, also vomited."
	"1272543-1"	"1272543-1"	"ARTHRALGIA"	"10003239"	"65-79 years"	"65-79"	"The following evening after the shot, he had severe pains in his back and shoulders, headache, nausea (vomited). 2 days later, felt severe pain in his stomach, along with pain in his shoulders and back, with a headache, also vomited."
	"1272543-1"	"1272543-1"	"BACK PAIN"	"10003988"	"65-79 years"	"65-79"	"The following evening after the shot, he had severe pains in his back and shoulders, headache, nausea (vomited). 2 days later, felt severe pain in his stomach, along with pain in his shoulders and back, with a headache, also vomited."
	"1272543-1"	"1272543-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	"The following evening after the shot, he had severe pains in his back and shoulders, headache, nausea (vomited). 2 days later, felt severe pain in his stomach, along with pain in his shoulders and back, with a headache, also vomited."
	"1272543-1"	"1272543-1"	"MYOCARDIAL INFARCTION"	"10028596"	"65-79 years"	"65-79"	"The following evening after the shot, he had severe pains in his back and shoulders, headache, nausea (vomited). 2 days later, felt severe pain in his stomach, along with pain in his shoulders and back, with a headache, also vomited."
	"1272543-1"	"1272543-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"The following evening after the shot, he had severe pains in his back and shoulders, headache, nausea (vomited). 2 days later, felt severe pain in his stomach, along with pain in his shoulders and back, with a headache, also vomited."
	"1272543-1"	"1272543-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"The following evening after the shot, he had severe pains in his back and shoulders, headache, nausea (vomited). 2 days later, felt severe pain in his stomach, along with pain in his shoulders and back, with a headache, also vomited."
	"1275726-1"	"1275726-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"massive Pulmonary embolism causing cardiac arrest"
	"1275726-1"	"1275726-1"	"PULMONARY EMBOLISM"	"10037377"	"65-79 years"	"65-79"	"massive Pulmonary embolism causing cardiac arrest"
	"1277990-1"	"1277990-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away, was notified by Coroner"
	"1281533-1"	"1281533-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Blood clot in the lungs, Death"
	"1281533-1"	"1281533-1"	"PULMONARY THROMBOSIS"	"10037437"	"65-79 years"	"65-79"	"Blood clot in the lungs, Death"
	"1284956-1"	"1284956-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"My mom was found dead at home 24 hours after having vaccine"
	"1290197-1"	"1290197-1"	"BRAIN OEDEMA"	"10048962"	"65-79 years"	"65-79"	"Cardiac arrest, seizures death"
	"1290197-1"	"1290197-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Cardiac arrest, seizures death"
	"1290197-1"	"1290197-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Cardiac arrest, seizures death"
	"1290197-1"	"1290197-1"	"SEIZURE"	"10039906"	"65-79 years"	"65-79"	"Cardiac arrest, seizures death"
	"1294370-1"	"1294370-1"	"CEREBRAL HAEMORRHAGE"	"10008111"	"65-79 years"	"65-79"	"Patient received the COVID-19 vaccine on Thursday, March 25, 2021. On Tuesday April 6, 2021 he had a massive stroke, blood clot to left side of his brain. On Friday morning April 9, 2021 doctor's advised he had another stroke due to bleeding in the brain  (paralysis on right side and racing heart beat). He died on Saturday, April 10, 2021 @ 5:45 AM."
	"1294370-1"	"1294370-1"	"CEREBRAL THROMBOSIS"	"10008132"	"65-79 years"	"65-79"	"Patient received the COVID-19 vaccine on Thursday, March 25, 2021. On Tuesday April 6, 2021 he had a massive stroke, blood clot to left side of his brain. On Friday morning April 9, 2021 doctor's advised he had another stroke due to bleeding in the brain  (paralysis on right side and racing heart beat). He died on Saturday, April 10, 2021 @ 5:45 AM."
	"1294370-1"	"1294370-1"	"CEREBROVASCULAR ACCIDENT"	"10008190"	"65-79 years"	"65-79"	"Patient received the COVID-19 vaccine on Thursday, March 25, 2021. On Tuesday April 6, 2021 he had a massive stroke, blood clot to left side of his brain. On Friday morning April 9, 2021 doctor's advised he had another stroke due to bleeding in the brain  (paralysis on right side and racing heart beat). He died on Saturday, April 10, 2021 @ 5:45 AM."
	"1294370-1"	"1294370-1"	"COMPUTERISED TOMOGRAM HEAD ABNORMAL"	"10072168"	"65-79 years"	"65-79"	"Patient received the COVID-19 vaccine on Thursday, March 25, 2021. On Tuesday April 6, 2021 he had a massive stroke, blood clot to left side of his brain. On Friday morning April 9, 2021 doctor's advised he had another stroke due to bleeding in the brain  (paralysis on right side and racing heart beat). He died on Saturday, April 10, 2021 @ 5:45 AM."
	"1294370-1"	"1294370-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received the COVID-19 vaccine on Thursday, March 25, 2021. On Tuesday April 6, 2021 he had a massive stroke, blood clot to left side of his brain. On Friday morning April 9, 2021 doctor's advised he had another stroke due to bleeding in the brain  (paralysis on right side and racing heart beat). He died on Saturday, April 10, 2021 @ 5:45 AM."
	"1294370-1"	"1294370-1"	"HEMIPLEGIA"	"10019468"	"65-79 years"	"65-79"	"Patient received the COVID-19 vaccine on Thursday, March 25, 2021. On Tuesday April 6, 2021 he had a massive stroke, blood clot to left side of his brain. On Friday morning April 9, 2021 doctor's advised he had another stroke due to bleeding in the brain  (paralysis on right side and racing heart beat). He died on Saturday, April 10, 2021 @ 5:45 AM."
	"1294370-1"	"1294370-1"	"MAGNETIC RESONANCE IMAGING HEAD ABNORMAL"	"10085256"	"65-79 years"	"65-79"	"Patient received the COVID-19 vaccine on Thursday, March 25, 2021. On Tuesday April 6, 2021 he had a massive stroke, blood clot to left side of his brain. On Friday morning April 9, 2021 doctor's advised he had another stroke due to bleeding in the brain  (paralysis on right side and racing heart beat). He died on Saturday, April 10, 2021 @ 5:45 AM."
	"1294370-1"	"1294370-1"	"PALPITATIONS"	"10033557"	"65-79 years"	"65-79"	"Patient received the COVID-19 vaccine on Thursday, March 25, 2021. On Tuesday April 6, 2021 he had a massive stroke, blood clot to left side of his brain. On Friday morning April 9, 2021 doctor's advised he had another stroke due to bleeding in the brain  (paralysis on right side and racing heart beat). He died on Saturday, April 10, 2021 @ 5:45 AM."
	"1299850-1"	"1299850-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"He became very ill and died this past Wednesday because he was told to get the shot even though he wasn't feeling well.  There is no excused for perpetuating the myth that everyone should get the shot no matter what.  A negative covid test and thorough physical should be required before people take this vaccine."
	"1299850-1"	"1299850-1"	"ILLNESS"	"10080284"	"65-79 years"	"65-79"	"He became very ill and died this past Wednesday because he was told to get the shot even though he wasn't feeling well.  There is no excused for perpetuating the myth that everyone should get the shot no matter what.  A negative covid test and thorough physical should be required before people take this vaccine."
	"1311196-1"	"1311196-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"ADENOVIRUS TEST"	"10050991"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"ARTERIAL CATHETERISATION"	"10003148"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"BLOOD GASES ABNORMAL"	"10005539"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"BORDETELLA TEST NEGATIVE"	"10070278"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"CENTRAL VENOUS CATHETERISATION"	"10053377"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"ENTEROVIRUS TEST NEGATIVE"	"10070397"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"ESSENTIAL HYPERTENSION"	"10015488"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"HUMAN METAPNEUMOVIRUS TEST"	"10072858"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"HUMAN RHINOVIRUS TEST"	"10075163"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"HYPERCAPNIA"	"10020591"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"HYPERCHOLESTEROLAEMIA"	"10020603"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"INFLUENZA A VIRUS TEST NEGATIVE"	"10070417"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"INFLUENZA B VIRUS TEST"	"10071544"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"MYCOPLASMA TEST NEGATIVE"	"10078590"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"RESPIRATORY SYNCYTIAL VIRUS TEST NEGATIVE"	"10068564"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"RESPIRATORY SYNCYTIAL VIRUS TEST POSITIVE"	"10068563"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"SEPTIC SHOCK"	"10040070"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311196-1"	"1311196-1"	"VITAMIN B12 DEFICIENCY"	"10047609"	"65-79 years"	"65-79"	"FEVER COUGH FATIGUE HEADACHES"
	"1311276-1"	"1311276-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"Pneumonia due to COVID-19 virus  ED to Hosp-Admission Discharged  4/14/2021 - 4/22/2021 (8 days)    Last attending ? Treatment team Maxillary fracture  Principal problem     Final Summary for Deceased Patient      Admission Date: 4/14/2021     Discharge Date: 4/22/2021   Final Diagnosis Principal Problem:   Maxillary fracture (CMS/HCC) Active Problems:   Pneumonia due to COVID-19 virus   Demand ischemia (CMS/HCC)   Dyslipidemia   Essential hypertension   Acute kidney injury (CMS/HCC)   Glomerulonephritis, IgA   Lactic acidosis   Septic shock (CMS/HCC)   Cytomegalovirus (CMV) viremia (CMS/HCC)   Acute respiratory failure with hypoxia (CMS/HCC)   Left femoral vein DVT (CMS/HCC)   Malnutrition (CMS/HCC)   Hypothermia     DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute respiratory failure with hypoxia (CMS/HCC) [J96.01] Fall, initial encounter [W19.XXXA] COVID-19 [U07.1] COVID-19 virus infection [U07.1]     Hospital Course Patient is a 72-year-old female with past medical history of hypertension, hyperlipidemia, recent hospitalization due to CMV viremia and an AKI and myelosuppression.  Who presented to the emergency room after a fall in her house on 4/14.  She had significant face pain and was hypoxic with an O2 saturation of 68% on room air on presentation.  She was then found to be Covid positive.  Initially admitted to the medical floor however required increasing amounts of oxygen and was ultimately transferred to the ICU on 4/16.  She was maintained on nonrebreather oxygen until the evening of 4/21 when she was intubated and increasing vasopressor requirements.  Given her worsening condition, her husband elected to palliatively extubate and pursue comfort care.  Time of death was 10:02 AM on 4/22/2021.     Disposition of the body: morgue"
	"1311276-1"	"1311276-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Pneumonia due to COVID-19 virus  ED to Hosp-Admission Discharged  4/14/2021 - 4/22/2021 (8 days)    Last attending ? Treatment team Maxillary fracture  Principal problem     Final Summary for Deceased Patient      Admission Date: 4/14/2021     Discharge Date: 4/22/2021   Final Diagnosis Principal Problem:   Maxillary fracture (CMS/HCC) Active Problems:   Pneumonia due to COVID-19 virus   Demand ischemia (CMS/HCC)   Dyslipidemia   Essential hypertension   Acute kidney injury (CMS/HCC)   Glomerulonephritis, IgA   Lactic acidosis   Septic shock (CMS/HCC)   Cytomegalovirus (CMV) viremia (CMS/HCC)   Acute respiratory failure with hypoxia (CMS/HCC)   Left femoral vein DVT (CMS/HCC)   Malnutrition (CMS/HCC)   Hypothermia     DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute respiratory failure with hypoxia (CMS/HCC) [J96.01] Fall, initial encounter [W19.XXXA] COVID-19 [U07.1] COVID-19 virus infection [U07.1]     Hospital Course Patient is a 72-year-old female with past medical history of hypertension, hyperlipidemia, recent hospitalization due to CMV viremia and an AKI and myelosuppression.  Who presented to the emergency room after a fall in her house on 4/14.  She had significant face pain and was hypoxic with an O2 saturation of 68% on room air on presentation.  She was then found to be Covid positive.  Initially admitted to the medical floor however required increasing amounts of oxygen and was ultimately transferred to the ICU on 4/16.  She was maintained on nonrebreather oxygen until the evening of 4/21 when she was intubated and increasing vasopressor requirements.  Given her worsening condition, her husband elected to palliatively extubate and pursue comfort care.  Time of death was 10:02 AM on 4/22/2021.     Disposition of the body: morgue"
	"1311276-1"	"1311276-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Pneumonia due to COVID-19 virus  ED to Hosp-Admission Discharged  4/14/2021 - 4/22/2021 (8 days)    Last attending ? Treatment team Maxillary fracture  Principal problem     Final Summary for Deceased Patient      Admission Date: 4/14/2021     Discharge Date: 4/22/2021   Final Diagnosis Principal Problem:   Maxillary fracture (CMS/HCC) Active Problems:   Pneumonia due to COVID-19 virus   Demand ischemia (CMS/HCC)   Dyslipidemia   Essential hypertension   Acute kidney injury (CMS/HCC)   Glomerulonephritis, IgA   Lactic acidosis   Septic shock (CMS/HCC)   Cytomegalovirus (CMV) viremia (CMS/HCC)   Acute respiratory failure with hypoxia (CMS/HCC)   Left femoral vein DVT (CMS/HCC)   Malnutrition (CMS/HCC)   Hypothermia     DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute respiratory failure with hypoxia (CMS/HCC) [J96.01] Fall, initial encounter [W19.XXXA] COVID-19 [U07.1] COVID-19 virus infection [U07.1]     Hospital Course Patient is a 72-year-old female with past medical history of hypertension, hyperlipidemia, recent hospitalization due to CMV viremia and an AKI and myelosuppression.  Who presented to the emergency room after a fall in her house on 4/14.  She had significant face pain and was hypoxic with an O2 saturation of 68% on room air on presentation.  She was then found to be Covid positive.  Initially admitted to the medical floor however required increasing amounts of oxygen and was ultimately transferred to the ICU on 4/16.  She was maintained on nonrebreather oxygen until the evening of 4/21 when she was intubated and increasing vasopressor requirements.  Given her worsening condition, her husband elected to palliatively extubate and pursue comfort care.  Time of death was 10:02 AM on 4/22/2021.     Disposition of the body: morgue"
	"1311276-1"	"1311276-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Pneumonia due to COVID-19 virus  ED to Hosp-Admission Discharged  4/14/2021 - 4/22/2021 (8 days)    Last attending ? Treatment team Maxillary fracture  Principal problem     Final Summary for Deceased Patient      Admission Date: 4/14/2021     Discharge Date: 4/22/2021   Final Diagnosis Principal Problem:   Maxillary fracture (CMS/HCC) Active Problems:   Pneumonia due to COVID-19 virus   Demand ischemia (CMS/HCC)   Dyslipidemia   Essential hypertension   Acute kidney injury (CMS/HCC)   Glomerulonephritis, IgA   Lactic acidosis   Septic shock (CMS/HCC)   Cytomegalovirus (CMV) viremia (CMS/HCC)   Acute respiratory failure with hypoxia (CMS/HCC)   Left femoral vein DVT (CMS/HCC)   Malnutrition (CMS/HCC)   Hypothermia     DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute respiratory failure with hypoxia (CMS/HCC) [J96.01] Fall, initial encounter [W19.XXXA] COVID-19 [U07.1] COVID-19 virus infection [U07.1]     Hospital Course Patient is a 72-year-old female with past medical history of hypertension, hyperlipidemia, recent hospitalization due to CMV viremia and an AKI and myelosuppression.  Who presented to the emergency room after a fall in her house on 4/14.  She had significant face pain and was hypoxic with an O2 saturation of 68% on room air on presentation.  She was then found to be Covid positive.  Initially admitted to the medical floor however required increasing amounts of oxygen and was ultimately transferred to the ICU on 4/16.  She was maintained on nonrebreather oxygen until the evening of 4/21 when she was intubated and increasing vasopressor requirements.  Given her worsening condition, her husband elected to palliatively extubate and pursue comfort care.  Time of death was 10:02 AM on 4/22/2021.     Disposition of the body: morgue"
	"1311276-1"	"1311276-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pneumonia due to COVID-19 virus  ED to Hosp-Admission Discharged  4/14/2021 - 4/22/2021 (8 days)    Last attending ? Treatment team Maxillary fracture  Principal problem     Final Summary for Deceased Patient      Admission Date: 4/14/2021     Discharge Date: 4/22/2021   Final Diagnosis Principal Problem:   Maxillary fracture (CMS/HCC) Active Problems:   Pneumonia due to COVID-19 virus   Demand ischemia (CMS/HCC)   Dyslipidemia   Essential hypertension   Acute kidney injury (CMS/HCC)   Glomerulonephritis, IgA   Lactic acidosis   Septic shock (CMS/HCC)   Cytomegalovirus (CMV) viremia (CMS/HCC)   Acute respiratory failure with hypoxia (CMS/HCC)   Left femoral vein DVT (CMS/HCC)   Malnutrition (CMS/HCC)   Hypothermia     DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute respiratory failure with hypoxia (CMS/HCC) [J96.01] Fall, initial encounter [W19.XXXA] COVID-19 [U07.1] COVID-19 virus infection [U07.1]     Hospital Course Patient is a 72-year-old female with past medical history of hypertension, hyperlipidemia, recent hospitalization due to CMV viremia and an AKI and myelosuppression.  Who presented to the emergency room after a fall in her house on 4/14.  She had significant face pain and was hypoxic with an O2 saturation of 68% on room air on presentation.  She was then found to be Covid positive.  Initially admitted to the medical floor however required increasing amounts of oxygen and was ultimately transferred to the ICU on 4/16.  She was maintained on nonrebreather oxygen until the evening of 4/21 when she was intubated and increasing vasopressor requirements.  Given her worsening condition, her husband elected to palliatively extubate and pursue comfort care.  Time of death was 10:02 AM on 4/22/2021.     Disposition of the body: morgue"
	"1311276-1"	"1311276-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Pneumonia due to COVID-19 virus  ED to Hosp-Admission Discharged  4/14/2021 - 4/22/2021 (8 days)    Last attending ? Treatment team Maxillary fracture  Principal problem     Final Summary for Deceased Patient      Admission Date: 4/14/2021     Discharge Date: 4/22/2021   Final Diagnosis Principal Problem:   Maxillary fracture (CMS/HCC) Active Problems:   Pneumonia due to COVID-19 virus   Demand ischemia (CMS/HCC)   Dyslipidemia   Essential hypertension   Acute kidney injury (CMS/HCC)   Glomerulonephritis, IgA   Lactic acidosis   Septic shock (CMS/HCC)   Cytomegalovirus (CMV) viremia (CMS/HCC)   Acute respiratory failure with hypoxia (CMS/HCC)   Left femoral vein DVT (CMS/HCC)   Malnutrition (CMS/HCC)   Hypothermia     DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute respiratory failure with hypoxia (CMS/HCC) [J96.01] Fall, initial encounter [W19.XXXA] COVID-19 [U07.1] COVID-19 virus infection [U07.1]     Hospital Course Patient is a 72-year-old female with past medical history of hypertension, hyperlipidemia, recent hospitalization due to CMV viremia and an AKI and myelosuppression.  Who presented to the emergency room after a fall in her house on 4/14.  She had significant face pain and was hypoxic with an O2 saturation of 68% on room air on presentation.  She was then found to be Covid positive.  Initially admitted to the medical floor however required increasing amounts of oxygen and was ultimately transferred to the ICU on 4/16.  She was maintained on nonrebreather oxygen until the evening of 4/21 when she was intubated and increasing vasopressor requirements.  Given her worsening condition, her husband elected to palliatively extubate and pursue comfort care.  Time of death was 10:02 AM on 4/22/2021.     Disposition of the body: morgue"
	"1311276-1"	"1311276-1"	"EXTUBATION"	"10015894"	"65-79 years"	"65-79"	"Pneumonia due to COVID-19 virus  ED to Hosp-Admission Discharged  4/14/2021 - 4/22/2021 (8 days)    Last attending ? Treatment team Maxillary fracture  Principal problem     Final Summary for Deceased Patient      Admission Date: 4/14/2021     Discharge Date: 4/22/2021   Final Diagnosis Principal Problem:   Maxillary fracture (CMS/HCC) Active Problems:   Pneumonia due to COVID-19 virus   Demand ischemia (CMS/HCC)   Dyslipidemia   Essential hypertension   Acute kidney injury (CMS/HCC)   Glomerulonephritis, IgA   Lactic acidosis   Septic shock (CMS/HCC)   Cytomegalovirus (CMV) viremia (CMS/HCC)   Acute respiratory failure with hypoxia (CMS/HCC)   Left femoral vein DVT (CMS/HCC)   Malnutrition (CMS/HCC)   Hypothermia     DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute respiratory failure with hypoxia (CMS/HCC) [J96.01] Fall, initial encounter [W19.XXXA] COVID-19 [U07.1] COVID-19 virus infection [U07.1]     Hospital Course Patient is a 72-year-old female with past medical history of hypertension, hyperlipidemia, recent hospitalization due to CMV viremia and an AKI and myelosuppression.  Who presented to the emergency room after a fall in her house on 4/14.  She had significant face pain and was hypoxic with an O2 saturation of 68% on room air on presentation.  She was then found to be Covid positive.  Initially admitted to the medical floor however required increasing amounts of oxygen and was ultimately transferred to the ICU on 4/16.  She was maintained on nonrebreather oxygen until the evening of 4/21 when she was intubated and increasing vasopressor requirements.  Given her worsening condition, her husband elected to palliatively extubate and pursue comfort care.  Time of death was 10:02 AM on 4/22/2021.     Disposition of the body: morgue"
	"1311276-1"	"1311276-1"	"FACIAL PAIN"	"10016059"	"65-79 years"	"65-79"	"Pneumonia due to COVID-19 virus  ED to Hosp-Admission Discharged  4/14/2021 - 4/22/2021 (8 days)    Last attending ? Treatment team Maxillary fracture  Principal problem     Final Summary for Deceased Patient      Admission Date: 4/14/2021     Discharge Date: 4/22/2021   Final Diagnosis Principal Problem:   Maxillary fracture (CMS/HCC) Active Problems:   Pneumonia due to COVID-19 virus   Demand ischemia (CMS/HCC)   Dyslipidemia   Essential hypertension   Acute kidney injury (CMS/HCC)   Glomerulonephritis, IgA   Lactic acidosis   Septic shock (CMS/HCC)   Cytomegalovirus (CMV) viremia (CMS/HCC)   Acute respiratory failure with hypoxia (CMS/HCC)   Left femoral vein DVT (CMS/HCC)   Malnutrition (CMS/HCC)   Hypothermia     DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute respiratory failure with hypoxia (CMS/HCC) [J96.01] Fall, initial encounter [W19.XXXA] COVID-19 [U07.1] COVID-19 virus infection [U07.1]     Hospital Course Patient is a 72-year-old female with past medical history of hypertension, hyperlipidemia, recent hospitalization due to CMV viremia and an AKI and myelosuppression.  Who presented to the emergency room after a fall in her house on 4/14.  She had significant face pain and was hypoxic with an O2 saturation of 68% on room air on presentation.  She was then found to be Covid positive.  Initially admitted to the medical floor however required increasing amounts of oxygen and was ultimately transferred to the ICU on 4/16.  She was maintained on nonrebreather oxygen until the evening of 4/21 when she was intubated and increasing vasopressor requirements.  Given her worsening condition, her husband elected to palliatively extubate and pursue comfort care.  Time of death was 10:02 AM on 4/22/2021.     Disposition of the body: morgue"
	"1311276-1"	"1311276-1"	"FALL"	"10016173"	"65-79 years"	"65-79"	"Pneumonia due to COVID-19 virus  ED to Hosp-Admission Discharged  4/14/2021 - 4/22/2021 (8 days)    Last attending ? Treatment team Maxillary fracture  Principal problem     Final Summary for Deceased Patient      Admission Date: 4/14/2021     Discharge Date: 4/22/2021   Final Diagnosis Principal Problem:   Maxillary fracture (CMS/HCC) Active Problems:   Pneumonia due to COVID-19 virus   Demand ischemia (CMS/HCC)   Dyslipidemia   Essential hypertension   Acute kidney injury (CMS/HCC)   Glomerulonephritis, IgA   Lactic acidosis   Septic shock (CMS/HCC)   Cytomegalovirus (CMV) viremia (CMS/HCC)   Acute respiratory failure with hypoxia (CMS/HCC)   Left femoral vein DVT (CMS/HCC)   Malnutrition (CMS/HCC)   Hypothermia     DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute respiratory failure with hypoxia (CMS/HCC) [J96.01] Fall, initial encounter [W19.XXXA] COVID-19 [U07.1] COVID-19 virus infection [U07.1]     Hospital Course Patient is a 72-year-old female with past medical history of hypertension, hyperlipidemia, recent hospitalization due to CMV viremia and an AKI and myelosuppression.  Who presented to the emergency room after a fall in her house on 4/14.  She had significant face pain and was hypoxic with an O2 saturation of 68% on room air on presentation.  She was then found to be Covid positive.  Initially admitted to the medical floor however required increasing amounts of oxygen and was ultimately transferred to the ICU on 4/16.  She was maintained on nonrebreather oxygen until the evening of 4/21 when she was intubated and increasing vasopressor requirements.  Given her worsening condition, her husband elected to palliatively extubate and pursue comfort care.  Time of death was 10:02 AM on 4/22/2021.     Disposition of the body: morgue"
	"1311276-1"	"1311276-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Pneumonia due to COVID-19 virus  ED to Hosp-Admission Discharged  4/14/2021 - 4/22/2021 (8 days)    Last attending ? Treatment team Maxillary fracture  Principal problem     Final Summary for Deceased Patient      Admission Date: 4/14/2021     Discharge Date: 4/22/2021   Final Diagnosis Principal Problem:   Maxillary fracture (CMS/HCC) Active Problems:   Pneumonia due to COVID-19 virus   Demand ischemia (CMS/HCC)   Dyslipidemia   Essential hypertension   Acute kidney injury (CMS/HCC)   Glomerulonephritis, IgA   Lactic acidosis   Septic shock (CMS/HCC)   Cytomegalovirus (CMV) viremia (CMS/HCC)   Acute respiratory failure with hypoxia (CMS/HCC)   Left femoral vein DVT (CMS/HCC)   Malnutrition (CMS/HCC)   Hypothermia     DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute respiratory failure with hypoxia (CMS/HCC) [J96.01] Fall, initial encounter [W19.XXXA] COVID-19 [U07.1] COVID-19 virus infection [U07.1]     Hospital Course Patient is a 72-year-old female with past medical history of hypertension, hyperlipidemia, recent hospitalization due to CMV viremia and an AKI and myelosuppression.  Who presented to the emergency room after a fall in her house on 4/14.  She had significant face pain and was hypoxic with an O2 saturation of 68% on room air on presentation.  She was then found to be Covid positive.  Initially admitted to the medical floor however required increasing amounts of oxygen and was ultimately transferred to the ICU on 4/16.  She was maintained on nonrebreather oxygen until the evening of 4/21 when she was intubated and increasing vasopressor requirements.  Given her worsening condition, her husband elected to palliatively extubate and pursue comfort care.  Time of death was 10:02 AM on 4/22/2021.     Disposition of the body: morgue"
	"1311276-1"	"1311276-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Pneumonia due to COVID-19 virus  ED to Hosp-Admission Discharged  4/14/2021 - 4/22/2021 (8 days)    Last attending ? Treatment team Maxillary fracture  Principal problem     Final Summary for Deceased Patient      Admission Date: 4/14/2021     Discharge Date: 4/22/2021   Final Diagnosis Principal Problem:   Maxillary fracture (CMS/HCC) Active Problems:   Pneumonia due to COVID-19 virus   Demand ischemia (CMS/HCC)   Dyslipidemia   Essential hypertension   Acute kidney injury (CMS/HCC)   Glomerulonephritis, IgA   Lactic acidosis   Septic shock (CMS/HCC)   Cytomegalovirus (CMV) viremia (CMS/HCC)   Acute respiratory failure with hypoxia (CMS/HCC)   Left femoral vein DVT (CMS/HCC)   Malnutrition (CMS/HCC)   Hypothermia     DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute respiratory failure with hypoxia (CMS/HCC) [J96.01] Fall, initial encounter [W19.XXXA] COVID-19 [U07.1] COVID-19 virus infection [U07.1]     Hospital Course Patient is a 72-year-old female with past medical history of hypertension, hyperlipidemia, recent hospitalization due to CMV viremia and an AKI and myelosuppression.  Who presented to the emergency room after a fall in her house on 4/14.  She had significant face pain and was hypoxic with an O2 saturation of 68% on room air on presentation.  She was then found to be Covid positive.  Initially admitted to the medical floor however required increasing amounts of oxygen and was ultimately transferred to the ICU on 4/16.  She was maintained on nonrebreather oxygen until the evening of 4/21 when she was intubated and increasing vasopressor requirements.  Given her worsening condition, her husband elected to palliatively extubate and pursue comfort care.  Time of death was 10:02 AM on 4/22/2021.     Disposition of the body: morgue"
	"1311276-1"	"1311276-1"	"JAW FRACTURE"	"10023149"	"65-79 years"	"65-79"	"Pneumonia due to COVID-19 virus  ED to Hosp-Admission Discharged  4/14/2021 - 4/22/2021 (8 days)    Last attending ? Treatment team Maxillary fracture  Principal problem     Final Summary for Deceased Patient      Admission Date: 4/14/2021     Discharge Date: 4/22/2021   Final Diagnosis Principal Problem:   Maxillary fracture (CMS/HCC) Active Problems:   Pneumonia due to COVID-19 virus   Demand ischemia (CMS/HCC)   Dyslipidemia   Essential hypertension   Acute kidney injury (CMS/HCC)   Glomerulonephritis, IgA   Lactic acidosis   Septic shock (CMS/HCC)   Cytomegalovirus (CMV) viremia (CMS/HCC)   Acute respiratory failure with hypoxia (CMS/HCC)   Left femoral vein DVT (CMS/HCC)   Malnutrition (CMS/HCC)   Hypothermia     DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute respiratory failure with hypoxia (CMS/HCC) [J96.01] Fall, initial encounter [W19.XXXA] COVID-19 [U07.1] COVID-19 virus infection [U07.1]     Hospital Course Patient is a 72-year-old female with past medical history of hypertension, hyperlipidemia, recent hospitalization due to CMV viremia and an AKI and myelosuppression.  Who presented to the emergency room after a fall in her house on 4/14.  She had significant face pain and was hypoxic with an O2 saturation of 68% on room air on presentation.  She was then found to be Covid positive.  Initially admitted to the medical floor however required increasing amounts of oxygen and was ultimately transferred to the ICU on 4/16.  She was maintained on nonrebreather oxygen until the evening of 4/21 when she was intubated and increasing vasopressor requirements.  Given her worsening condition, her husband elected to palliatively extubate and pursue comfort care.  Time of death was 10:02 AM on 4/22/2021.     Disposition of the body: morgue"
	"1311276-1"	"1311276-1"	"OXYGEN THERAPY"	"10078798"	"65-79 years"	"65-79"	"Pneumonia due to COVID-19 virus  ED to Hosp-Admission Discharged  4/14/2021 - 4/22/2021 (8 days)    Last attending ? Treatment team Maxillary fracture  Principal problem     Final Summary for Deceased Patient      Admission Date: 4/14/2021     Discharge Date: 4/22/2021   Final Diagnosis Principal Problem:   Maxillary fracture (CMS/HCC) Active Problems:   Pneumonia due to COVID-19 virus   Demand ischemia (CMS/HCC)   Dyslipidemia   Essential hypertension   Acute kidney injury (CMS/HCC)   Glomerulonephritis, IgA   Lactic acidosis   Septic shock (CMS/HCC)   Cytomegalovirus (CMV) viremia (CMS/HCC)   Acute respiratory failure with hypoxia (CMS/HCC)   Left femoral vein DVT (CMS/HCC)   Malnutrition (CMS/HCC)   Hypothermia     DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute respiratory failure with hypoxia (CMS/HCC) [J96.01] Fall, initial encounter [W19.XXXA] COVID-19 [U07.1] COVID-19 virus infection [U07.1]     Hospital Course Patient is a 72-year-old female with past medical history of hypertension, hyperlipidemia, recent hospitalization due to CMV viremia and an AKI and myelosuppression.  Who presented to the emergency room after a fall in her house on 4/14.  She had significant face pain and was hypoxic with an O2 saturation of 68% on room air on presentation.  She was then found to be Covid positive.  Initially admitted to the medical floor however required increasing amounts of oxygen and was ultimately transferred to the ICU on 4/16.  She was maintained on nonrebreather oxygen until the evening of 4/21 when she was intubated and increasing vasopressor requirements.  Given her worsening condition, her husband elected to palliatively extubate and pursue comfort care.  Time of death was 10:02 AM on 4/22/2021.     Disposition of the body: morgue"
	"1311276-1"	"1311276-1"	"RESPIRATORY FAILURE"	"10038695"	"65-79 years"	"65-79"	"Pneumonia due to COVID-19 virus  ED to Hosp-Admission Discharged  4/14/2021 - 4/22/2021 (8 days)    Last attending ? Treatment team Maxillary fracture  Principal problem     Final Summary for Deceased Patient      Admission Date: 4/14/2021     Discharge Date: 4/22/2021   Final Diagnosis Principal Problem:   Maxillary fracture (CMS/HCC) Active Problems:   Pneumonia due to COVID-19 virus   Demand ischemia (CMS/HCC)   Dyslipidemia   Essential hypertension   Acute kidney injury (CMS/HCC)   Glomerulonephritis, IgA   Lactic acidosis   Septic shock (CMS/HCC)   Cytomegalovirus (CMV) viremia (CMS/HCC)   Acute respiratory failure with hypoxia (CMS/HCC)   Left femoral vein DVT (CMS/HCC)   Malnutrition (CMS/HCC)   Hypothermia     DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute respiratory failure with hypoxia (CMS/HCC) [J96.01] Fall, initial encounter [W19.XXXA] COVID-19 [U07.1] COVID-19 virus infection [U07.1]     Hospital Course Patient is a 72-year-old female with past medical history of hypertension, hyperlipidemia, recent hospitalization due to CMV viremia and an AKI and myelosuppression.  Who presented to the emergency room after a fall in her house on 4/14.  She had significant face pain and was hypoxic with an O2 saturation of 68% on room air on presentation.  She was then found to be Covid positive.  Initially admitted to the medical floor however required increasing amounts of oxygen and was ultimately transferred to the ICU on 4/16.  She was maintained on nonrebreather oxygen until the evening of 4/21 when she was intubated and increasing vasopressor requirements.  Given her worsening condition, her husband elected to palliatively extubate and pursue comfort care.  Time of death was 10:02 AM on 4/22/2021.     Disposition of the body: morgue"
	"1311276-1"	"1311276-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Pneumonia due to COVID-19 virus  ED to Hosp-Admission Discharged  4/14/2021 - 4/22/2021 (8 days)    Last attending ? Treatment team Maxillary fracture  Principal problem     Final Summary for Deceased Patient      Admission Date: 4/14/2021     Discharge Date: 4/22/2021   Final Diagnosis Principal Problem:   Maxillary fracture (CMS/HCC) Active Problems:   Pneumonia due to COVID-19 virus   Demand ischemia (CMS/HCC)   Dyslipidemia   Essential hypertension   Acute kidney injury (CMS/HCC)   Glomerulonephritis, IgA   Lactic acidosis   Septic shock (CMS/HCC)   Cytomegalovirus (CMV) viremia (CMS/HCC)   Acute respiratory failure with hypoxia (CMS/HCC)   Left femoral vein DVT (CMS/HCC)   Malnutrition (CMS/HCC)   Hypothermia     DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute respiratory failure with hypoxia (CMS/HCC) [J96.01] Fall, initial encounter [W19.XXXA] COVID-19 [U07.1] COVID-19 virus infection [U07.1]     Hospital Course Patient is a 72-year-old female with past medical history of hypertension, hyperlipidemia, recent hospitalization due to CMV viremia and an AKI and myelosuppression.  Who presented to the emergency room after a fall in her house on 4/14.  She had significant face pain and was hypoxic with an O2 saturation of 68% on room air on presentation.  She was then found to be Covid positive.  Initially admitted to the medical floor however required increasing amounts of oxygen and was ultimately transferred to the ICU on 4/16.  She was maintained on nonrebreather oxygen until the evening of 4/21 when she was intubated and increasing vasopressor requirements.  Given her worsening condition, her husband elected to palliatively extubate and pursue comfort care.  Time of death was 10:02 AM on 4/22/2021.     Disposition of the body: morgue"
	"1311276-1"	"1311276-1"	"SKIN LACERATION"	"10058818"	"65-79 years"	"65-79"	"Pneumonia due to COVID-19 virus  ED to Hosp-Admission Discharged  4/14/2021 - 4/22/2021 (8 days)    Last attending ? Treatment team Maxillary fracture  Principal problem     Final Summary for Deceased Patient      Admission Date: 4/14/2021     Discharge Date: 4/22/2021   Final Diagnosis Principal Problem:   Maxillary fracture (CMS/HCC) Active Problems:   Pneumonia due to COVID-19 virus   Demand ischemia (CMS/HCC)   Dyslipidemia   Essential hypertension   Acute kidney injury (CMS/HCC)   Glomerulonephritis, IgA   Lactic acidosis   Septic shock (CMS/HCC)   Cytomegalovirus (CMV) viremia (CMS/HCC)   Acute respiratory failure with hypoxia (CMS/HCC)   Left femoral vein DVT (CMS/HCC)   Malnutrition (CMS/HCC)   Hypothermia     DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute respiratory failure with hypoxia (CMS/HCC) [J96.01] Fall, initial encounter [W19.XXXA] COVID-19 [U07.1] COVID-19 virus infection [U07.1]     Hospital Course Patient is a 72-year-old female with past medical history of hypertension, hyperlipidemia, recent hospitalization due to CMV viremia and an AKI and myelosuppression.  Who presented to the emergency room after a fall in her house on 4/14.  She had significant face pain and was hypoxic with an O2 saturation of 68% on room air on presentation.  She was then found to be Covid positive.  Initially admitted to the medical floor however required increasing amounts of oxygen and was ultimately transferred to the ICU on 4/16.  She was maintained on nonrebreather oxygen until the evening of 4/21 when she was intubated and increasing vasopressor requirements.  Given her worsening condition, her husband elected to palliatively extubate and pursue comfort care.  Time of death was 10:02 AM on 4/22/2021.     Disposition of the body: morgue"
	"1313837-1"	"1313837-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"He died 24 hours later after receiving the vaccine!"
	"1313931-1"	"1313931-1"	"ABDOMINAL X-RAY"	"10061612"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"ADENOVIRUS TEST"	"10050991"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"AORTIC ARTERIOSCLEROSIS"	"10065558"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"BORDETELLA TEST NEGATIVE"	"10070278"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"CHLAMYDIA TEST NEGATIVE"	"10070273"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"COMPUTERISED TOMOGRAM THORAX ABNORMAL"	"10057799"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"DIARRHOEA"	"10012735"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"DYSURIA"	"10013990"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"ECHOCARDIOGRAM"	"10014113"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"ECHOCARDIOGRAM NORMAL"	"10014115"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"ENTEROVIRUS TEST NEGATIVE"	"10070397"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"EXTUBATION"	"10015894"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"HUMAN METAPNEUMOVIRUS TEST"	"10072858"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"HUMAN RHINOVIRUS TEST"	"10075163"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"INFLUENZA A VIRUS TEST NEGATIVE"	"10070417"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"INFLUENZA B VIRUS TEST"	"10071544"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"LIFE SUPPORT"	"10024447"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"LUNG CONSOLIDATION"	"10025080"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"LUNG INFILTRATION"	"10025102"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"LUNG OPACITY"	"10081792"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"MYCOPLASMA TEST NEGATIVE"	"10078590"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"PLEURAL EFFUSION"	"10035598"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"PNEUMOTHORAX"	"10035759"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"POOR QUALITY SLEEP"	"10062519"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"PRODUCTIVE COUGH"	"10036790"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"RESPIRATORY SYNCYTIAL VIRUS TEST NEGATIVE"	"10068564"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"RESPIRATORY VIRAL PANEL"	"10075165"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"SCAN WITH CONTRAST ABNORMAL"	"10062152"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"SEPSIS"	"10040047"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"VIRAL TEST NEGATIVE"	"10062362"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1313931-1"	"1313931-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"ED Discharged  4/4/2021 (4 hours) Hospital Emergency Department  Last attending ? Treatment team Generalized weakness +4 more Clinical impression Weakness - Generalized ? Chills Chief complaint ED Provider Notes Emergency Medicine Expand AllCollapse All      HPI      Chief Complaint Patient presents with ? Weakness - Generalized ? Chills     HPI 79-year-old female, history of COPD for which she wears oxygen at night and as needed, also with a history of leukemia and obesity who presents to the ED complaining of generalized body aches, fevers up to 103, feeling generally unwell and weak, poor sleep, onset 3 to 4 days ago.  Patient reports that she received her second COVID-19 vaccine approximately 1 week ago.  Tolerated this without any particular symptoms.  She has had 2 days of watery/nonbloody diarrhea.  Does admit to nausea with several episodes of vomiting earlier today.  She is denying any particular abdominal pain.  Does believe she felt her urine burning earlier today but has had no gross hematuria.  Denies any flank pain.  No ill contacts although her husband has been at home with a slight cough.  Patient does have a cough presently but it is nonproductive.  She is denying any particular chest pain or subjective shortness of breath.  No rash or unusual lower extremity pain, swelling, or redness.    ED to Hosp-Admission Discharged  4/6/2021 - 4/17/2021 (11 days) Hospital  Last attending ? Treatment team Severe sepsis (CMS/HCC) Principal problem Discharge Summary Internal Medicine    Inpatient DeathSummary   BRIEF OVERVIEW Admission Date: 4/6/2021     Discharge Date: 4/17/2021  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Patient is an 79 y.o. female morbidly obese with past medical history of chronic lymphocytic leukemia follow-up that was initially scheduled oncology follow-up for April 7 now postponed to the next 2 weeks, COPD on 2 L oxygen support at home, GERD, depression and anxiety.  She was recently seen in the ED on April 4, 2021 with complaint of shortness of breath, nonproductive cough, fever, chills, nonbloody diarrhea, vomiting and weakness and subsequently diagnosed with COVID-19.  She had however received a second dose of COVID-19 a week before and was  discharged home due to lack of significant findings on imaging chest x-ray and lack of requirement for higher  oxygen support. She presented to the emergency via EMS for evaluation of progressive shortness of breath with associated with fever, chills, headache, persistent shortness of breath, cough productive of thick clear sputum, nausea, vomiting and diarrhea.  She denies abdominal pain, chest pain, or dizziness.  Denies recent antibiotic usage or recent travel.  Apparently, she thought she was getting better upon discharge after being kept for about 12 hours in the last ED visit, however she was not feeling well after going to bed last night and asked the husband to call 911.  Upon EMS arrival patient was saturating in the 80s and in respiratory distress.  She received 1 DuoNeb and was eventually placed on 10 L oxygen support.  She was noted to be in significant respiratory distress during speech.   Hospital Course Patient was admitted to hospital due to shortness of breath, and was found to have severe sepsis on presentation due to COVID-19 pneumonia.  She had evidence of acute on chronic hypoxic respiratory failure as well.  She was started on IV antibiotics, as well as remdesivir and Decadron at high dose.   Unfortunately she continued to have clinical deterioration, and ultimately required high flow oxygen therapy.  She was then transferred to the ICU, and ultimately required intubation due to severe profound ongoing hypoxia despite optimal medical treatment.  She did not respond to remdesivir or steroids or antibiotics.  Post intubation, she also developed acute renal failure during the course of her admission.   Multiple discussions were had throughout the hospitalization regarding goals of care, and initially patient and family wish to be continually aggressive.  She received full medical treatment, including life support, with minimal improvement.  Despite being on ventilator for roughly 5 days, she continued to have severe hypoxia.  She was proned, and was unable to sustain oxygen saturations when supine even for short period.   Her renal function continued to decline as well, and at that point discussion was had with family regarding goals of care again.  They were explained that symptoms continue to be persistent, and her illness continues to progress despite aggressive medical therapy.  Ultimately decision was made to not pursue dialysis, and to allow the patient to be kept comfortable and pass away naturally from this infection.   She was terminally extubated on 4/17 and passed away at 11:16 AM due to COVID-19 and acute on chronic hypoxic respiratory failure.   Operative Procedures Performed X-ray Abdomen 1 View   Result Date: 4/13/2021 Narrative: Single view portable abdomen INDICATION: Nasogastric tube placement, encounter initial Supine portable view of the lower chest and abdomen demonstrates nasogastric tube with tip and side-port in the gas-distended stomach. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/16/2021 Narrative: XR CHEST 1 VW IMPRESSION: No significant change from the previous examination. END OF IMPRESSION: INDICATION: Worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/13/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. Right-sided chest tube is unchanged. There is a small left pleural effusion. There is diffuse bilateral hazy airspace opacification. No change from prior. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/15/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Tubes and lines as described. Small left effusion. Unchanged patchy bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening hypoxemia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/14/2021. FINDINGS: The endotracheal tube, nasogastric tube, and right IJ central venous catheter are unchanged. The right-sided chest tube is unchanged. There is no pneumothorax. There is a small effusion. There is diffuse bilateral patchy airspace consolidation. There is no significant change. Cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Daily   Result Date: 4/14/2021 Narrative: Chest radiograph HISTORY: Covid 19 infection. Mechanical ventilation. Comments: Frontal radiograph of the chest was obtained and compared to the prior study dated 4/13/2021. The heart is at the upper limits of normal. The mediastinum is within normal limits. Interstitial alveolar opacities are demonstrated bilaterally consistent with pneumonia. There is an endotracheal tube with the distal end approximately 4.3 cm from the carina. Nasogastric tube is noted directed towards the stomach. There is a right jugular central catheter. A right-sided pigtail catheter is seen. IMPRESSION: 1. Persistent bilateral interstitial alveolar opacities consistent with pneumonia. 2. Lines and tubes in place as described. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/14/2021 Narrative: PROCEDURE INFORMATION: Exam: XR Chest Exam date and time: 4/13/2021 11:46 PM Age: 79 years old Clinical indication: Hypoxia; Covid+ TECHNIQUE: Imaging protocol: XR of the chest. Views: 1 view. COMPARISON: DX XR CHEST 1 VW 4/13/2021 10:50 AM FINDINGS: Tubes, catheters and devices: Endotracheal tube tip located at the level of the carina. Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. Nasogastric tube enters the stomach but tip not included on the image. Tip of right internal jugular central venous catheter in SVC. Cardiac leads superimposed over the chest bilaterally. Lungs: Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. Pleural spaces: Small right apical pneumothorax (12 mm). New small left pleural fluid collection. No right pleural fluid collection. Heart/Mediastinum:  Stable cardiac silhouette Bones/joints: Unremarkable for age. IMPRESSION: 1.  Endotracheal tube tip located at the level of the carina. 2.  Pigtail drainage catheter tip remains superimposed over the lateral right mid lung zone. 3.  Small right apical pneumothorax (12 mm). 4.  Compared to chest x-ray examination performed earlier on 04/13/2021 at 1051 hrs, new consolidation and/or atelectasis in the left lung base. 5.  New small left pleural fluid collection. 6.  No significant interval change in scattered patches of ground-glass opacity (GGO) within each lung. Patient has history of COVID-19. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT INDICATION: verify placement of right chest tube.  Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: Earlier today. FINDINGS: The left thoracostomy tube terminates near the lateral right midlung. No other change. Extensive pulmonary infiltrates. Stable life support lines. The previous right pneumothorax has predominantly resolved, only a thin crescent of air caps the right apex. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View, Portable   Result Date: 4/13/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Lines as described. There is a small right-sided pneumothorax. Unchanged bilateral airspace consolidation. END OF IMPRESSION: INDICATION: verify placement of CVC and post intubation. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/11/2021. FINDINGS: There is a right IJ central venous catheter. Tip is projected over the SVC. There is a small right apical pneumothorax. Endotracheal tube terminates 2 cm superior to the carina. The nasogastric tube passes beneath the diaphragm. Multifocal areas of patchy airspace consolidation bilaterally. Findings do not appear significantly changed from prior. The cardiac silhouette is normal size. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/11/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mildly worsened bilateral airspace consolidation. END OF IMPRESSION: INDICATION: worsening respiratory failure, covid pneumonia worsening respiratory failure, covid pneumonia. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/8/2021. FINDINGS: The left costophrenic angle is partially excluded. The lungs are adequately expanded. There are large areas of patchy airspace consolidation bilaterally. Findings have mildly increased in severity. There is no effusion or pneumothorax. The cardiac silhouette is mildly enlarged. There is calcification of the aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View   Result Date: 4/8/2021 Narrative: XR CHEST 1 VW PORT INDICATION: Worsening hypoxemia, Covid pneumonia.  Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/4/2021. FINDINGS: Scattered pulmonary infiltrates is developed bilaterally, greatest in the right upper and right lower lobe. No change in the heart, mediastinum, or bony thorax. IMPRESSIONS: Developing pulmonary infiltrates. END OF IMPRESSION: This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   X-ray Chest 1 View - Portable   Result Date: 4/4/2021 Narrative: XR CHEST 1 VW PORT IMPRESSION: No evidence of acute pulmonary disease. END OF IMPRESSION: INDICATION: SOB, weak, cough SOB, weak, cough. TECHNIQUE: Portable AP projection of the chest is acquired. COMPARISON: 6/5/2020 FINDINGS: Heart size appears unremarkable. There is mild prominence of pulmonary arteries. This is stable. There is no focal consolidation or effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.   Transthoracic Echo (tte) Complete   Result Date: 4/11/2021 Narrative: Gender: Female Age: 79 Procedure Date: 4/11/2021 10:19 AM Study Quality: Fair Ht / Wt / BSA: 66.00 in /  218.00 lb /  2.07 m2 Heart Rate: 77 bpm BP: 181 / 81 mmHg Indications: Arrhythmia           Transthoracic 2D, Color Flow, and Doppler Echocardiogram      Conclusions: The left ventricle is normal in size.          Ejection Fraction 55% (normal range 50-70%).   All wall segments showed normal motion.        Mild concentric LVH.                           Trivial aortic regurgitation.                  No additional significant valvular abnormality. No prior study for comparison.                 Presentation and History: Indication: The patient presents for evaluation of arrhythmia.  The patient has a history of obesity and chronic obstructive pulmonary disease. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications.  Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: The left ventricle is normal in size.  There is mildly increased left ventricular wall thickness.  The left ventricular systolic function is normal.  The visually estimated ejection fraction is 55% (normal range 50 70%). Wall Motion: All wall segments showed normal motion. Right Ventricle: RV not well visualized.  RV grossly normal in size and function by subcostal view. Atria: The left atrium is borderline dilated.  The right atrium is normal in size. Aortic Valve: Sclerotic appearing aortic valve with no significant aortic stenosis. Trivial aortic regurgitation. Mitral Valve: There is trace mitral valve regurgitation by color flow and doppler analysis.  There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: There is no evidence of significant pulmonic valvular stenosis or insufficiency by color flow and doppler analysis. Tricuspid Valve: There is trace tricuspid valve regurgitation by color flow and doppler analysis. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava is normal in size and collapses greater than 50% with inspiration. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison.                                             Measurements: Left Ventricle: IVSd: 0.85 cm (0.6-0.9/0.6-1.0) LVIDd: 5.10 cm (3.9-5.3/4.2-5.9) LVIDd Index: 2.46 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 3.56 cm (2.0-3.6) LVPWd: 0.95 cm (0.7-1.1) Ao Root: 3.30 cm (2.1-3.5) LV Mass: 203.25 g (67-162/88-224) LV Mass Index: 98.19 g/m2 (43-95/49-115) LVOT Diam: 1.90 cm (3.0+(-)1.3) LVOT Pk Vel: 0.91 LVOT Mn Vel: 0.63 LVOT VTI: 0.20 LVOT Pk Grad: 3.00 LVOT Mn Grad: 2.00 LVOT Diam: 1.90 LVOT Area: 2.84 MV Pk E: 0.66 MV Pk A: 0.66 E/A: 1.00 E'Medial: 5.33 E/E' Med: 12.30 E' Laterial: 10.60 E/E' Lat: 6.20   Mitral Valve: MV Pk E: 0.66 MV PK A: 0.66 MV Decel Time: 209.00 E/A: 1.00 E'Lateral: 10.60 E'Medial: 5.33 E/E' Med: 12.30 E/E' Lat: 6.20 PHT: 61.00 MVA PHT: 3.61 Decel Slope: 3.14   Aortic Valve: AoV Pk Vel: 1.65 AoV Mn Vel: 1.22 AoV VTI: 0.39 AoV Pk Grad: 11.00 Aov Mn Grad: 7.00 AVA Cont.VTI: 1.42  Tricuspid Valve: TR Pk Vel: 2.89 TR Pk Grad: 33.00 RA Press: 10.00 RVSP: 43.00   Great Vessels: Ao Root-2D: 3.30 cm (2.0-3.7) Ao Asc: 3.30 cm (2.1-3.4)      Updated on 4/11/2021 5:10:04 PM with Status of Final           electronically signed on 4/11/2021 5:10:04 PM with status of Final                                         Ct Covid Chest Low Dose Without Contrast   Result Date: 4/6/2021 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 4/6/2021 4:21 AM Age: 79 years old Clinical indication: Cough and shortness of breath; Patient HX: +covid; Additional info: Cough. Shortness of breath, covid TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 3/8/2021 2:28 PM FINDINGS: Lungs: There are patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No cardiomegaly. No pericardial effusion. Aorta: Atherosclerotic changes of the aorta. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: Patchy peripheral ground-glass opacities which can be seen with atypical pneumonia. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD"
	"1314186-1"	"1314186-1"	"ABDOMINAL PAIN"	"10000081"	"65-79 years"	"65-79"	"? Sore Throat ? Cough ? Abdominal Pain Diarrhea Sinus congestion"
	"1314186-1"	"1314186-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"? Sore Throat ? Cough ? Abdominal Pain Diarrhea Sinus congestion"
	"1314186-1"	"1314186-1"	"DIARRHOEA"	"10012735"	"65-79 years"	"65-79"	"? Sore Throat ? Cough ? Abdominal Pain Diarrhea Sinus congestion"
	"1314186-1"	"1314186-1"	"OROPHARYNGEAL PAIN"	"10068319"	"65-79 years"	"65-79"	"? Sore Throat ? Cough ? Abdominal Pain Diarrhea Sinus congestion"
	"1314186-1"	"1314186-1"	"SARS-COV-2 TEST"	"10084354"	"65-79 years"	"65-79"	"? Sore Throat ? Cough ? Abdominal Pain Diarrhea Sinus congestion"
	"1314186-1"	"1314186-1"	"SINUS CONGESTION"	"10040742"	"65-79 years"	"65-79"	"? Sore Throat ? Cough ? Abdominal Pain Diarrhea Sinus congestion"
	"1314461-1"	"1314461-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Passed away in his sleep 28 hours after vaccine.  No illness prior."
	"1318152-1"	"1318152-1"	"ABDOMINAL PAIN"	"10000081"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"ANTICOAGULANT THERAPY"	"10053468"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"CATHETERISATION CARDIAC NORMAL"	"10007817"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"DECREASED ACTIVITY"	"10011953"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"DECREASED APPETITE"	"10061428"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"DYSPEPSIA"	"10013946"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"EJECTION FRACTION DECREASED"	"10050528"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"FEELING ABNORMAL"	"10016322"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"FLUID RETENTION"	"10016807"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"FUNGAEMIA"	"10017523"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"GENERALISED OEDEMA"	"10018092"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"HEADACHE"	"10019211"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"LEFT VENTRICULAR FAILURE"	"10024119"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"MESENTERIC VEIN THROMBOSIS"	"10027402"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"PERIPHERAL SWELLING"	"10048959"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"POOR QUALITY SLEEP"	"10062519"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"SEDATIVE THERAPY"	"10059283"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"SEPTIC SHOCK"	"10040070"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"SUPRAVENTRICULAR TACHYCARDIA"	"10042604"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1318152-1"	"1318152-1"	"URINARY TRACT INFECTION"	"10046571"	"65-79 years"	"65-79"	""(Information gained secondhand from patient's close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of ""just not feeling right"" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed ""water pill"" and told to ""lay off salt,"". Friends later found out that she had lied about doctor's visit and was self-medicating with over the counter  ""water pills"" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21.  Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose.  Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.""
	"1327666-1"	"1327666-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient received second Pfizer vaccine on 2/8/2021. Became symptomatic with COVID like S/S on 4/30/2021. Was admitted to Hospital on 5/4/2021  and tested positive for COVID 19 upon admission. Patient was intubated on 5/12/21 and expired while still admitted to the hospital on 5/17/21."
	"1327666-1"	"1327666-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received second Pfizer vaccine on 2/8/2021. Became symptomatic with COVID like S/S on 4/30/2021. Was admitted to Hospital on 5/4/2021  and tested positive for COVID 19 upon admission. Patient was intubated on 5/12/21 and expired while still admitted to the hospital on 5/17/21."
	"1327666-1"	"1327666-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Patient received second Pfizer vaccine on 2/8/2021. Became symptomatic with COVID like S/S on 4/30/2021. Was admitted to Hospital on 5/4/2021  and tested positive for COVID 19 upon admission. Patient was intubated on 5/12/21 and expired while still admitted to the hospital on 5/17/21."
	"1330767-1"	"1330767-1"	"ACUTE LEFT VENTRICULAR FAILURE"	"10063081"	"65-79 years"	"65-79"	"Patient presented to the ER on 3/28/2021 with shortness of breath and lower extremity edema and complaining of lower back pain. O2 sat high 80s on room air. Worsening renal failure since last discharge from hospital on 3/23/2021.   Patient was readmitted to hospital from skilled care facility after being discharged 5 days prior with acute on chronic stage IV kidney disease as well as acute on chronic diastolic heart failure and had slowly worsening with renal dysfunction and growing concern for dialysis.   Patient had developed a cough, a fever up to 101, and 1 questionable sewed of either hemoptysis or hematemesis since being discharged to skilled nursing facility on 3/23/2021. Patient was transitioned to the hospice team and expired on 4/2/2021."
	"1330767-1"	"1330767-1"	"BACK PAIN"	"10003988"	"65-79 years"	"65-79"	"Patient presented to the ER on 3/28/2021 with shortness of breath and lower extremity edema and complaining of lower back pain. O2 sat high 80s on room air. Worsening renal failure since last discharge from hospital on 3/23/2021.   Patient was readmitted to hospital from skilled care facility after being discharged 5 days prior with acute on chronic stage IV kidney disease as well as acute on chronic diastolic heart failure and had slowly worsening with renal dysfunction and growing concern for dialysis.   Patient had developed a cough, a fever up to 101, and 1 questionable sewed of either hemoptysis or hematemesis since being discharged to skilled nursing facility on 3/23/2021. Patient was transitioned to the hospice team and expired on 4/2/2021."
	"1330767-1"	"1330767-1"	"CHRONIC KIDNEY DISEASE"	"10064848"	"65-79 years"	"65-79"	"Patient presented to the ER on 3/28/2021 with shortness of breath and lower extremity edema and complaining of lower back pain. O2 sat high 80s on room air. Worsening renal failure since last discharge from hospital on 3/23/2021.   Patient was readmitted to hospital from skilled care facility after being discharged 5 days prior with acute on chronic stage IV kidney disease as well as acute on chronic diastolic heart failure and had slowly worsening with renal dysfunction and growing concern for dialysis.   Patient had developed a cough, a fever up to 101, and 1 questionable sewed of either hemoptysis or hematemesis since being discharged to skilled nursing facility on 3/23/2021. Patient was transitioned to the hospice team and expired on 4/2/2021."
	"1330767-1"	"1330767-1"	"CHRONIC LEFT VENTRICULAR FAILURE"	"10063083"	"65-79 years"	"65-79"	"Patient presented to the ER on 3/28/2021 with shortness of breath and lower extremity edema and complaining of lower back pain. O2 sat high 80s on room air. Worsening renal failure since last discharge from hospital on 3/23/2021.   Patient was readmitted to hospital from skilled care facility after being discharged 5 days prior with acute on chronic stage IV kidney disease as well as acute on chronic diastolic heart failure and had slowly worsening with renal dysfunction and growing concern for dialysis.   Patient had developed a cough, a fever up to 101, and 1 questionable sewed of either hemoptysis or hematemesis since being discharged to skilled nursing facility on 3/23/2021. Patient was transitioned to the hospice team and expired on 4/2/2021."
	"1330767-1"	"1330767-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Patient presented to the ER on 3/28/2021 with shortness of breath and lower extremity edema and complaining of lower back pain. O2 sat high 80s on room air. Worsening renal failure since last discharge from hospital on 3/23/2021.   Patient was readmitted to hospital from skilled care facility after being discharged 5 days prior with acute on chronic stage IV kidney disease as well as acute on chronic diastolic heart failure and had slowly worsening with renal dysfunction and growing concern for dialysis.   Patient had developed a cough, a fever up to 101, and 1 questionable sewed of either hemoptysis or hematemesis since being discharged to skilled nursing facility on 3/23/2021. Patient was transitioned to the hospice team and expired on 4/2/2021."
	"1330767-1"	"1330767-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Patient presented to the ER on 3/28/2021 with shortness of breath and lower extremity edema and complaining of lower back pain. O2 sat high 80s on room air. Worsening renal failure since last discharge from hospital on 3/23/2021.   Patient was readmitted to hospital from skilled care facility after being discharged 5 days prior with acute on chronic stage IV kidney disease as well as acute on chronic diastolic heart failure and had slowly worsening with renal dysfunction and growing concern for dialysis.   Patient had developed a cough, a fever up to 101, and 1 questionable sewed of either hemoptysis or hematemesis since being discharged to skilled nursing facility on 3/23/2021. Patient was transitioned to the hospice team and expired on 4/2/2021."
	"1330767-1"	"1330767-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient presented to the ER on 3/28/2021 with shortness of breath and lower extremity edema and complaining of lower back pain. O2 sat high 80s on room air. Worsening renal failure since last discharge from hospital on 3/23/2021.   Patient was readmitted to hospital from skilled care facility after being discharged 5 days prior with acute on chronic stage IV kidney disease as well as acute on chronic diastolic heart failure and had slowly worsening with renal dysfunction and growing concern for dialysis.   Patient had developed a cough, a fever up to 101, and 1 questionable sewed of either hemoptysis or hematemesis since being discharged to skilled nursing facility on 3/23/2021. Patient was transitioned to the hospice team and expired on 4/2/2021."
	"1330767-1"	"1330767-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient presented to the ER on 3/28/2021 with shortness of breath and lower extremity edema and complaining of lower back pain. O2 sat high 80s on room air. Worsening renal failure since last discharge from hospital on 3/23/2021.   Patient was readmitted to hospital from skilled care facility after being discharged 5 days prior with acute on chronic stage IV kidney disease as well as acute on chronic diastolic heart failure and had slowly worsening with renal dysfunction and growing concern for dialysis.   Patient had developed a cough, a fever up to 101, and 1 questionable sewed of either hemoptysis or hematemesis since being discharged to skilled nursing facility on 3/23/2021. Patient was transitioned to the hospice team and expired on 4/2/2021."
	"1330767-1"	"1330767-1"	"OEDEMA PERIPHERAL"	"10030124"	"65-79 years"	"65-79"	"Patient presented to the ER on 3/28/2021 with shortness of breath and lower extremity edema and complaining of lower back pain. O2 sat high 80s on room air. Worsening renal failure since last discharge from hospital on 3/23/2021.   Patient was readmitted to hospital from skilled care facility after being discharged 5 days prior with acute on chronic stage IV kidney disease as well as acute on chronic diastolic heart failure and had slowly worsening with renal dysfunction and growing concern for dialysis.   Patient had developed a cough, a fever up to 101, and 1 questionable sewed of either hemoptysis or hematemesis since being discharged to skilled nursing facility on 3/23/2021. Patient was transitioned to the hospice team and expired on 4/2/2021."
	"1330767-1"	"1330767-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"Patient presented to the ER on 3/28/2021 with shortness of breath and lower extremity edema and complaining of lower back pain. O2 sat high 80s on room air. Worsening renal failure since last discharge from hospital on 3/23/2021.   Patient was readmitted to hospital from skilled care facility after being discharged 5 days prior with acute on chronic stage IV kidney disease as well as acute on chronic diastolic heart failure and had slowly worsening with renal dysfunction and growing concern for dialysis.   Patient had developed a cough, a fever up to 101, and 1 questionable sewed of either hemoptysis or hematemesis since being discharged to skilled nursing facility on 3/23/2021. Patient was transitioned to the hospice team and expired on 4/2/2021."
	"1330767-1"	"1330767-1"	"RENAL IMPAIRMENT"	"10062237"	"65-79 years"	"65-79"	"Patient presented to the ER on 3/28/2021 with shortness of breath and lower extremity edema and complaining of lower back pain. O2 sat high 80s on room air. Worsening renal failure since last discharge from hospital on 3/23/2021.   Patient was readmitted to hospital from skilled care facility after being discharged 5 days prior with acute on chronic stage IV kidney disease as well as acute on chronic diastolic heart failure and had slowly worsening with renal dysfunction and growing concern for dialysis.   Patient had developed a cough, a fever up to 101, and 1 questionable sewed of either hemoptysis or hematemesis since being discharged to skilled nursing facility on 3/23/2021. Patient was transitioned to the hospice team and expired on 4/2/2021."
	"1333218-1"	"1333218-1"	"ABDOMINAL DISTENSION"	"10000060"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"ABDOMINAL HERNIA"	"10060954"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"ABDOMINAL PAIN LOWER"	"10000084"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"ABDOMINAL TENDERNESS"	"10000097"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"ADENOVIRUS TEST"	"10050991"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"AORTIC ARTERIOSCLEROSIS"	"10065558"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"ARTERIAL CATHETERISATION"	"10003148"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"BILEVEL POSITIVE AIRWAY PRESSURE"	"10064530"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"BLADDER CATHETERISATION"	"10005028"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"BLOOD GASES"	"10005537"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"BLOOD LACTIC ACID"	"10005632"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"BORDETELLA TEST NEGATIVE"	"10070278"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"BREATH SOUNDS ABNORMAL"	"10064780"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"CENTRAL VENOUS CATHETERISATION"	"10053377"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"CHLAMYDIA TEST NEGATIVE"	"10070273"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"CHOLELITHIASIS"	"10008629"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"COLECTOMY"	"10061778"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"COLONIC ABSCESS"	"10073573"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"COLONIC FISTULA"	"10009995"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"COLOSTOMY"	"10010041"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"COMPUTERISED TOMOGRAM ABDOMEN"	"10053876"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"COMPUTERISED TOMOGRAM THORAX"	"10053875"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"DIVERTICULITIS"	"10013538"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"DIZZINESS"	"10013573"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"DYSPNOEA EXERTIONAL"	"10013971"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"ELECTROCARDIOGRAM ABNORMAL"	"10014363"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"ELECTROCARDIOGRAM T WAVE INVERSION"	"10014395"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"EMOTIONAL DISTRESS"	"10049119"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"ENTERITIS"	"10014866"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"ENTEROVIRUS TEST NEGATIVE"	"10070397"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"EXPLORATIVE LAPAROTOMY"	"10053361"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"GASTROINTESTINAL OEDEMA"	"10058061"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"GASTROINTESTINAL TUBE INSERTION"	"10053050"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"HUMAN METAPNEUMOVIRUS TEST"	"10072858"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"HUMAN RHINOVIRUS TEST"	"10075163"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"HYPOAESTHESIA"	"10020937"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"INFLUENZA A VIRUS TEST NEGATIVE"	"10070417"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"INFLUENZA VIRUS TEST NEGATIVE"	"10070718"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"INGUINAL HERNIA"	"10022016"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"INTERVERTEBRAL DISC SPACE NARROWING"	"10055041"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"LACTIC ACIDOSIS"	"10023676"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"LARGE INTESTINE PERFORATION"	"10023804"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"LUNG CONSOLIDATION"	"10025080"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"LUNG INFILTRATION"	"10025102"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"LUNG OPACITY"	"10081792"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"MYCOPLASMA TEST NEGATIVE"	"10078590"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"PARAESTHESIA"	"10033775"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"PNEUMONIA"	"10035664"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"PNEUMOPERITONEUM"	"10048299"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"PRONE POSITION"	"10074744"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"PULMONARY MASS"	"10056342"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"RENAL CYST"	"10038423"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"RESPIRATORY SYNCYTIAL VIRUS TEST NEGATIVE"	"10068564"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"RESPIRATORY VIRAL PANEL"	"10075165"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"SCAN WITH CONTRAST ABNORMAL"	"10062152"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"SEDATIVE THERAPY"	"10059283"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"SEPSIS"	"10040047"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"SPINAL DISORDER"	"10061368"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"SPINAL STENOSIS"	"10082214"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"TACHYCARDIA"	"10043071"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"USE OF ACCESSORY RESPIRATORY MUSCLES"	"10069555"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"VERTEBRAL FORAMINAL STENOSIS"	"10069690"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"VIRAL TEST NEGATIVE"	"10062362"	"65-79 years"	"65-79"	"No event description for this event."
	"1333218-1"	"1333218-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"No event description for this event."
	"1343387-1"	"1343387-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient died of a myocardial infarction."
	"1343387-1"	"1343387-1"	"MYOCARDIAL INFARCTION"	"10028596"	"65-79 years"	"65-79"	"Patient died of a myocardial infarction."
	"1349711-1"	"1349711-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"65-79 years"	"65-79"	"Symptoms: & cardiopulmonary arrest Treatment: EPINEPHRINE 8 MG Unknown during code"
	"1354193-1"	"1354193-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient received second COVID 19 vaccine on 4/13/21 at Site. Patient tested positive for COVID on 5/16/2021. Patient had worsened short of breath on 5/25/2021 and was admitted to Medical and placed on a vent. Patient expired on 5/26/2021."
	"1354193-1"	"1354193-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received second COVID 19 vaccine on 4/13/21 at Site. Patient tested positive for COVID on 5/16/2021. Patient had worsened short of breath on 5/25/2021 and was admitted to Medical and placed on a vent. Patient expired on 5/26/2021."
	"1354193-1"	"1354193-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient received second COVID 19 vaccine on 4/13/21 at Site. Patient tested positive for COVID on 5/16/2021. Patient had worsened short of breath on 5/25/2021 and was admitted to Medical and placed on a vent. Patient expired on 5/26/2021."
	"1354193-1"	"1354193-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Patient received second COVID 19 vaccine on 4/13/21 at Site. Patient tested positive for COVID on 5/16/2021. Patient had worsened short of breath on 5/25/2021 and was admitted to Medical and placed on a vent. Patient expired on 5/26/2021."
	"1354193-1"	"1354193-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient received second COVID 19 vaccine on 4/13/21 at Site. Patient tested positive for COVID on 5/16/2021. Patient had worsened short of breath on 5/25/2021 and was admitted to Medical and placed on a vent. Patient expired on 5/26/2021."
	"1355095-1"	"1355095-1"	"ARTHRALGIA"	"10003239"	"65-79 years"	"65-79"	"Daughter reporting after her mother's death .  She got her vaccine and called her daughter in the afternoon around 2:00 and told her that she got it.  At 6:00 she received a VM where she said that she was having joint pain and wanted to know if she could call her doctor to get her joint pain medicine.  Later that evening her daughter told her that was why she was put on the Hydroxychloroquine and they wanted her to see the rheumatologist.  She complained of pain a lot, but she specifically asked for joint pain medicine.  On the 22nd on another VM her daughter noticed that she sounded raspy hoarse sounding and congested and had a cough.  Then subsequent messages after that the hoarseness was there that didn't go away.  Her daughter took her to the dentist on 4/15/21 and she remembered that the caregiver told her that she did not want to go to the dentist as she did not feel good.  She did not like to get out of the apartment.  Then on 4/19/21 she was admitted to the hospital and that she had pneumonia.  They were going to discharge her home and she was going to pick her up on 4/22/21, and then they called her back and told her that she sounded junky and they were going to keep her another day.  She made arrangements to pick her up on Friday and then her oxygens dropped and would discharge her on Monday.    She normally gets oxygen 1 liter of oxygen only at night, and when she was admitted her oxygen levels were low and they put her on 6 liters when she was admitted.  Then she was weaned off oxygen completely, and her daughter informed them that she slept with oxygen and that's when they were talking about going home.  On Friday she dropped her oxygen level into the 60's  On Saturday 4/24/21 she was on 9 liters of oxygen and the doctor came in and said that she was on 14.  By Saturday night she was on the Critical care Unit, but her on Vancomycin and was on Vapotherm on high-flow oxygen and she had maxed out at 40 liters at 100% oxygen.   They talked to the daughter about putting her on ventilation and thought it was toxicity to Vancomycin and other things and couldn't figure it out and said that it was some sort of inflammation of her lungs.  They put her on high levels of steroids and was then taken off of high-flow oxygen and then was still on 20% liters.  They recommended hospice and palliative care.  They decided to bring her home on Hospice with 15 liters of oxygen.  It was up and down levels.  She was given steroids when she came home on Hospice and was given steroids.  She then started to decline and hospice nurse came and she was admitted to Hershey and they repeated her chest x-ray and COVID testing, and that her lungs were so scarred there was nothing that they could do for her.  They tested her for COVID multiple times, the CAT Scans came back that it was worsening and consistent with COVID but tested negative twice while was there.  She was then sent to Hospital and tested again and was negative, and she passed on 5/10/2021.    HOSPITAL ADMISSIONS: She was admitted to  on 4/19/21 discharged home on hospice on 5/6/21.    She was admitted to Medical Center on 5/6/21 and she died on 5/10/21 at 5:48 PM."
	"1355095-1"	"1355095-1"	"BREATH SOUNDS ABNORMAL"	"10064780"	"65-79 years"	"65-79"	"Daughter reporting after her mother's death .  She got her vaccine and called her daughter in the afternoon around 2:00 and told her that she got it.  At 6:00 she received a VM where she said that she was having joint pain and wanted to know if she could call her doctor to get her joint pain medicine.  Later that evening her daughter told her that was why she was put on the Hydroxychloroquine and they wanted her to see the rheumatologist.  She complained of pain a lot, but she specifically asked for joint pain medicine.  On the 22nd on another VM her daughter noticed that she sounded raspy hoarse sounding and congested and had a cough.  Then subsequent messages after that the hoarseness was there that didn't go away.  Her daughter took her to the dentist on 4/15/21 and she remembered that the caregiver told her that she did not want to go to the dentist as she did not feel good.  She did not like to get out of the apartment.  Then on 4/19/21 she was admitted to the hospital and that she had pneumonia.  They were going to discharge her home and she was going to pick her up on 4/22/21, and then they called her back and told her that she sounded junky and they were going to keep her another day.  She made arrangements to pick her up on Friday and then her oxygens dropped and would discharge her on Monday.    She normally gets oxygen 1 liter of oxygen only at night, and when she was admitted her oxygen levels were low and they put her on 6 liters when she was admitted.  Then she was weaned off oxygen completely, and her daughter informed them that she slept with oxygen and that's when they were talking about going home.  On Friday she dropped her oxygen level into the 60's  On Saturday 4/24/21 she was on 9 liters of oxygen and the doctor came in and said that she was on 14.  By Saturday night she was on the Critical care Unit, but her on Vancomycin and was on Vapotherm on high-flow oxygen and she had maxed out at 40 liters at 100% oxygen.   They talked to the daughter about putting her on ventilation and thought it was toxicity to Vancomycin and other things and couldn't figure it out and said that it was some sort of inflammation of her lungs.  They put her on high levels of steroids and was then taken off of high-flow oxygen and then was still on 20% liters.  They recommended hospice and palliative care.  They decided to bring her home on Hospice with 15 liters of oxygen.  It was up and down levels.  She was given steroids when she came home on Hospice and was given steroids.  She then started to decline and hospice nurse came and she was admitted to Hershey and they repeated her chest x-ray and COVID testing, and that her lungs were so scarred there was nothing that they could do for her.  They tested her for COVID multiple times, the CAT Scans came back that it was worsening and consistent with COVID but tested negative twice while was there.  She was then sent to Hospital and tested again and was negative, and she passed on 5/10/2021.    HOSPITAL ADMISSIONS: She was admitted to  on 4/19/21 discharged home on hospice on 5/6/21.    She was admitted to Medical Center on 5/6/21 and she died on 5/10/21 at 5:48 PM."
	"1355095-1"	"1355095-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"Daughter reporting after her mother's death .  She got her vaccine and called her daughter in the afternoon around 2:00 and told her that she got it.  At 6:00 she received a VM where she said that she was having joint pain and wanted to know if she could call her doctor to get her joint pain medicine.  Later that evening her daughter told her that was why she was put on the Hydroxychloroquine and they wanted her to see the rheumatologist.  She complained of pain a lot, but she specifically asked for joint pain medicine.  On the 22nd on another VM her daughter noticed that she sounded raspy hoarse sounding and congested and had a cough.  Then subsequent messages after that the hoarseness was there that didn't go away.  Her daughter took her to the dentist on 4/15/21 and she remembered that the caregiver told her that she did not want to go to the dentist as she did not feel good.  She did not like to get out of the apartment.  Then on 4/19/21 she was admitted to the hospital and that she had pneumonia.  They were going to discharge her home and she was going to pick her up on 4/22/21, and then they called her back and told her that she sounded junky and they were going to keep her another day.  She made arrangements to pick her up on Friday and then her oxygens dropped and would discharge her on Monday.    She normally gets oxygen 1 liter of oxygen only at night, and when she was admitted her oxygen levels were low and they put her on 6 liters when she was admitted.  Then she was weaned off oxygen completely, and her daughter informed them that she slept with oxygen and that's when they were talking about going home.  On Friday she dropped her oxygen level into the 60's  On Saturday 4/24/21 she was on 9 liters of oxygen and the doctor came in and said that she was on 14.  By Saturday night she was on the Critical care Unit, but her on Vancomycin and was on Vapotherm on high-flow oxygen and she had maxed out at 40 liters at 100% oxygen.   They talked to the daughter about putting her on ventilation and thought it was toxicity to Vancomycin and other things and couldn't figure it out and said that it was some sort of inflammation of her lungs.  They put her on high levels of steroids and was then taken off of high-flow oxygen and then was still on 20% liters.  They recommended hospice and palliative care.  They decided to bring her home on Hospice with 15 liters of oxygen.  It was up and down levels.  She was given steroids when she came home on Hospice and was given steroids.  She then started to decline and hospice nurse came and she was admitted to Hershey and they repeated her chest x-ray and COVID testing, and that her lungs were so scarred there was nothing that they could do for her.  They tested her for COVID multiple times, the CAT Scans came back that it was worsening and consistent with COVID but tested negative twice while was there.  She was then sent to Hospital and tested again and was negative, and she passed on 5/10/2021.    HOSPITAL ADMISSIONS: She was admitted to  on 4/19/21 discharged home on hospice on 5/6/21.    She was admitted to Medical Center on 5/6/21 and she died on 5/10/21 at 5:48 PM."
	"1355095-1"	"1355095-1"	"COMPUTERISED TOMOGRAM THORAX ABNORMAL"	"10057799"	"65-79 years"	"65-79"	"Daughter reporting after her mother's death .  She got her vaccine and called her daughter in the afternoon around 2:00 and told her that she got it.  At 6:00 she received a VM where she said that she was having joint pain and wanted to know if she could call her doctor to get her joint pain medicine.  Later that evening her daughter told her that was why she was put on the Hydroxychloroquine and they wanted her to see the rheumatologist.  She complained of pain a lot, but she specifically asked for joint pain medicine.  On the 22nd on another VM her daughter noticed that she sounded raspy hoarse sounding and congested and had a cough.  Then subsequent messages after that the hoarseness was there that didn't go away.  Her daughter took her to the dentist on 4/15/21 and she remembered that the caregiver told her that she did not want to go to the dentist as she did not feel good.  She did not like to get out of the apartment.  Then on 4/19/21 she was admitted to the hospital and that she had pneumonia.  They were going to discharge her home and she was going to pick her up on 4/22/21, and then they called her back and told her that she sounded junky and they were going to keep her another day.  She made arrangements to pick her up on Friday and then her oxygens dropped and would discharge her on Monday.    She normally gets oxygen 1 liter of oxygen only at night, and when she was admitted her oxygen levels were low and they put her on 6 liters when she was admitted.  Then she was weaned off oxygen completely, and her daughter informed them that she slept with oxygen and that's when they were talking about going home.  On Friday she dropped her oxygen level into the 60's  On Saturday 4/24/21 she was on 9 liters of oxygen and the doctor came in and said that she was on 14.  By Saturday night she was on the Critical care Unit, but her on Vancomycin and was on Vapotherm on high-flow oxygen and she had maxed out at 40 liters at 100% oxygen.   They talked to the daughter about putting her on ventilation and thought it was toxicity to Vancomycin and other things and couldn't figure it out and said that it was some sort of inflammation of her lungs.  They put her on high levels of steroids and was then taken off of high-flow oxygen and then was still on 20% liters.  They recommended hospice and palliative care.  They decided to bring her home on Hospice with 15 liters of oxygen.  It was up and down levels.  She was given steroids when she came home on Hospice and was given steroids.  She then started to decline and hospice nurse came and she was admitted to Hershey and they repeated her chest x-ray and COVID testing, and that her lungs were so scarred there was nothing that they could do for her.  They tested her for COVID multiple times, the CAT Scans came back that it was worsening and consistent with COVID but tested negative twice while was there.  She was then sent to Hospital and tested again and was negative, and she passed on 5/10/2021.    HOSPITAL ADMISSIONS: She was admitted to  on 4/19/21 discharged home on hospice on 5/6/21.    She was admitted to Medical Center on 5/6/21 and she died on 5/10/21 at 5:48 PM."
	"1355095-1"	"1355095-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Daughter reporting after her mother's death .  She got her vaccine and called her daughter in the afternoon around 2:00 and told her that she got it.  At 6:00 she received a VM where she said that she was having joint pain and wanted to know if she could call her doctor to get her joint pain medicine.  Later that evening her daughter told her that was why she was put on the Hydroxychloroquine and they wanted her to see the rheumatologist.  She complained of pain a lot, but she specifically asked for joint pain medicine.  On the 22nd on another VM her daughter noticed that she sounded raspy hoarse sounding and congested and had a cough.  Then subsequent messages after that the hoarseness was there that didn't go away.  Her daughter took her to the dentist on 4/15/21 and she remembered that the caregiver told her that she did not want to go to the dentist as she did not feel good.  She did not like to get out of the apartment.  Then on 4/19/21 she was admitted to the hospital and that she had pneumonia.  They were going to discharge her home and she was going to pick her up on 4/22/21, and then they called her back and told her that she sounded junky and they were going to keep her another day.  She made arrangements to pick her up on Friday and then her oxygens dropped and would discharge her on Monday.    She normally gets oxygen 1 liter of oxygen only at night, and when she was admitted her oxygen levels were low and they put her on 6 liters when she was admitted.  Then she was weaned off oxygen completely, and her daughter informed them that she slept with oxygen and that's when they were talking about going home.  On Friday she dropped her oxygen level into the 60's  On Saturday 4/24/21 she was on 9 liters of oxygen and the doctor came in and said that she was on 14.  By Saturday night she was on the Critical care Unit, but her on Vancomycin and was on Vapotherm on high-flow oxygen and she had maxed out at 40 liters at 100% oxygen.   They talked to the daughter about putting her on ventilation and thought it was toxicity to Vancomycin and other things and couldn't figure it out and said that it was some sort of inflammation of her lungs.  They put her on high levels of steroids and was then taken off of high-flow oxygen and then was still on 20% liters.  They recommended hospice and palliative care.  They decided to bring her home on Hospice with 15 liters of oxygen.  It was up and down levels.  She was given steroids when she came home on Hospice and was given steroids.  She then started to decline and hospice nurse came and she was admitted to Hershey and they repeated her chest x-ray and COVID testing, and that her lungs were so scarred there was nothing that they could do for her.  They tested her for COVID multiple times, the CAT Scans came back that it was worsening and consistent with COVID but tested negative twice while was there.  She was then sent to Hospital and tested again and was negative, and she passed on 5/10/2021.    HOSPITAL ADMISSIONS: She was admitted to  on 4/19/21 discharged home on hospice on 5/6/21.    She was admitted to Medical Center on 5/6/21 and she died on 5/10/21 at 5:48 PM."
	"1355095-1"	"1355095-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Daughter reporting after her mother's death .  She got her vaccine and called her daughter in the afternoon around 2:00 and told her that she got it.  At 6:00 she received a VM where she said that she was having joint pain and wanted to know if she could call her doctor to get her joint pain medicine.  Later that evening her daughter told her that was why she was put on the Hydroxychloroquine and they wanted her to see the rheumatologist.  She complained of pain a lot, but she specifically asked for joint pain medicine.  On the 22nd on another VM her daughter noticed that she sounded raspy hoarse sounding and congested and had a cough.  Then subsequent messages after that the hoarseness was there that didn't go away.  Her daughter took her to the dentist on 4/15/21 and she remembered that the caregiver told her that she did not want to go to the dentist as she did not feel good.  She did not like to get out of the apartment.  Then on 4/19/21 she was admitted to the hospital and that she had pneumonia.  They were going to discharge her home and she was going to pick her up on 4/22/21, and then they called her back and told her that she sounded junky and they were going to keep her another day.  She made arrangements to pick her up on Friday and then her oxygens dropped and would discharge her on Monday.    She normally gets oxygen 1 liter of oxygen only at night, and when she was admitted her oxygen levels were low and they put her on 6 liters when she was admitted.  Then she was weaned off oxygen completely, and her daughter informed them that she slept with oxygen and that's when they were talking about going home.  On Friday she dropped her oxygen level into the 60's  On Saturday 4/24/21 she was on 9 liters of oxygen and the doctor came in and said that she was on 14.  By Saturday night she was on the Critical care Unit, but her on Vancomycin and was on Vapotherm on high-flow oxygen and she had maxed out at 40 liters at 100% oxygen.   They talked to the daughter about putting her on ventilation and thought it was toxicity to Vancomycin and other things and couldn't figure it out and said that it was some sort of inflammation of her lungs.  They put her on high levels of steroids and was then taken off of high-flow oxygen and then was still on 20% liters.  They recommended hospice and palliative care.  They decided to bring her home on Hospice with 15 liters of oxygen.  It was up and down levels.  She was given steroids when she came home on Hospice and was given steroids.  She then started to decline and hospice nurse came and she was admitted to Hershey and they repeated her chest x-ray and COVID testing, and that her lungs were so scarred there was nothing that they could do for her.  They tested her for COVID multiple times, the CAT Scans came back that it was worsening and consistent with COVID but tested negative twice while was there.  She was then sent to Hospital and tested again and was negative, and she passed on 5/10/2021.    HOSPITAL ADMISSIONS: She was admitted to  on 4/19/21 discharged home on hospice on 5/6/21.    She was admitted to Medical Center on 5/6/21 and she died on 5/10/21 at 5:48 PM."
	"1355095-1"	"1355095-1"	"DYSPHONIA"	"10013952"	"65-79 years"	"65-79"	"Daughter reporting after her mother's death .  She got her vaccine and called her daughter in the afternoon around 2:00 and told her that she got it.  At 6:00 she received a VM where she said that she was having joint pain and wanted to know if she could call her doctor to get her joint pain medicine.  Later that evening her daughter told her that was why she was put on the Hydroxychloroquine and they wanted her to see the rheumatologist.  She complained of pain a lot, but she specifically asked for joint pain medicine.  On the 22nd on another VM her daughter noticed that she sounded raspy hoarse sounding and congested and had a cough.  Then subsequent messages after that the hoarseness was there that didn't go away.  Her daughter took her to the dentist on 4/15/21 and she remembered that the caregiver told her that she did not want to go to the dentist as she did not feel good.  She did not like to get out of the apartment.  Then on 4/19/21 she was admitted to the hospital and that she had pneumonia.  They were going to discharge her home and she was going to pick her up on 4/22/21, and then they called her back and told her that she sounded junky and they were going to keep her another day.  She made arrangements to pick her up on Friday and then her oxygens dropped and would discharge her on Monday.    She normally gets oxygen 1 liter of oxygen only at night, and when she was admitted her oxygen levels were low and they put her on 6 liters when she was admitted.  Then she was weaned off oxygen completely, and her daughter informed them that she slept with oxygen and that's when they were talking about going home.  On Friday she dropped her oxygen level into the 60's  On Saturday 4/24/21 she was on 9 liters of oxygen and the doctor came in and said that she was on 14.  By Saturday night she was on the Critical care Unit, but her on Vancomycin and was on Vapotherm on high-flow oxygen and she had maxed out at 40 liters at 100% oxygen.   They talked to the daughter about putting her on ventilation and thought it was toxicity to Vancomycin and other things and couldn't figure it out and said that it was some sort of inflammation of her lungs.  They put her on high levels of steroids and was then taken off of high-flow oxygen and then was still on 20% liters.  They recommended hospice and palliative care.  They decided to bring her home on Hospice with 15 liters of oxygen.  It was up and down levels.  She was given steroids when she came home on Hospice and was given steroids.  She then started to decline and hospice nurse came and she was admitted to Hershey and they repeated her chest x-ray and COVID testing, and that her lungs were so scarred there was nothing that they could do for her.  They tested her for COVID multiple times, the CAT Scans came back that it was worsening and consistent with COVID but tested negative twice while was there.  She was then sent to Hospital and tested again and was negative, and she passed on 5/10/2021.    HOSPITAL ADMISSIONS: She was admitted to  on 4/19/21 discharged home on hospice on 5/6/21.    She was admitted to Medical Center on 5/6/21 and she died on 5/10/21 at 5:48 PM."
	"1355095-1"	"1355095-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Daughter reporting after her mother's death .  She got her vaccine and called her daughter in the afternoon around 2:00 and told her that she got it.  At 6:00 she received a VM where she said that she was having joint pain and wanted to know if she could call her doctor to get her joint pain medicine.  Later that evening her daughter told her that was why she was put on the Hydroxychloroquine and they wanted her to see the rheumatologist.  She complained of pain a lot, but she specifically asked for joint pain medicine.  On the 22nd on another VM her daughter noticed that she sounded raspy hoarse sounding and congested and had a cough.  Then subsequent messages after that the hoarseness was there that didn't go away.  Her daughter took her to the dentist on 4/15/21 and she remembered that the caregiver told her that she did not want to go to the dentist as she did not feel good.  She did not like to get out of the apartment.  Then on 4/19/21 she was admitted to the hospital and that she had pneumonia.  They were going to discharge her home and she was going to pick her up on 4/22/21, and then they called her back and told her that she sounded junky and they were going to keep her another day.  She made arrangements to pick her up on Friday and then her oxygens dropped and would discharge her on Monday.    She normally gets oxygen 1 liter of oxygen only at night, and when she was admitted her oxygen levels were low and they put her on 6 liters when she was admitted.  Then she was weaned off oxygen completely, and her daughter informed them that she slept with oxygen and that's when they were talking about going home.  On Friday she dropped her oxygen level into the 60's  On Saturday 4/24/21 she was on 9 liters of oxygen and the doctor came in and said that she was on 14.  By Saturday night she was on the Critical care Unit, but her on Vancomycin and was on Vapotherm on high-flow oxygen and she had maxed out at 40 liters at 100% oxygen.   They talked to the daughter about putting her on ventilation and thought it was toxicity to Vancomycin and other things and couldn't figure it out and said that it was some sort of inflammation of her lungs.  They put her on high levels of steroids and was then taken off of high-flow oxygen and then was still on 20% liters.  They recommended hospice and palliative care.  They decided to bring her home on Hospice with 15 liters of oxygen.  It was up and down levels.  She was given steroids when she came home on Hospice and was given steroids.  She then started to decline and hospice nurse came and she was admitted to Hershey and they repeated her chest x-ray and COVID testing, and that her lungs were so scarred there was nothing that they could do for her.  They tested her for COVID multiple times, the CAT Scans came back that it was worsening and consistent with COVID but tested negative twice while was there.  She was then sent to Hospital and tested again and was negative, and she passed on 5/10/2021.    HOSPITAL ADMISSIONS: She was admitted to  on 4/19/21 discharged home on hospice on 5/6/21.    She was admitted to Medical Center on 5/6/21 and she died on 5/10/21 at 5:48 PM."
	"1355095-1"	"1355095-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Daughter reporting after her mother's death .  She got her vaccine and called her daughter in the afternoon around 2:00 and told her that she got it.  At 6:00 she received a VM where she said that she was having joint pain and wanted to know if she could call her doctor to get her joint pain medicine.  Later that evening her daughter told her that was why she was put on the Hydroxychloroquine and they wanted her to see the rheumatologist.  She complained of pain a lot, but she specifically asked for joint pain medicine.  On the 22nd on another VM her daughter noticed that she sounded raspy hoarse sounding and congested and had a cough.  Then subsequent messages after that the hoarseness was there that didn't go away.  Her daughter took her to the dentist on 4/15/21 and she remembered that the caregiver told her that she did not want to go to the dentist as she did not feel good.  She did not like to get out of the apartment.  Then on 4/19/21 she was admitted to the hospital and that she had pneumonia.  They were going to discharge her home and she was going to pick her up on 4/22/21, and then they called her back and told her that she sounded junky and they were going to keep her another day.  She made arrangements to pick her up on Friday and then her oxygens dropped and would discharge her on Monday.    She normally gets oxygen 1 liter of oxygen only at night, and when she was admitted her oxygen levels were low and they put her on 6 liters when she was admitted.  Then she was weaned off oxygen completely, and her daughter informed them that she slept with oxygen and that's when they were talking about going home.  On Friday she dropped her oxygen level into the 60's  On Saturday 4/24/21 she was on 9 liters of oxygen and the doctor came in and said that she was on 14.  By Saturday night she was on the Critical care Unit, but her on Vancomycin and was on Vapotherm on high-flow oxygen and she had maxed out at 40 liters at 100% oxygen.   They talked to the daughter about putting her on ventilation and thought it was toxicity to Vancomycin and other things and couldn't figure it out and said that it was some sort of inflammation of her lungs.  They put her on high levels of steroids and was then taken off of high-flow oxygen and then was still on 20% liters.  They recommended hospice and palliative care.  They decided to bring her home on Hospice with 15 liters of oxygen.  It was up and down levels.  She was given steroids when she came home on Hospice and was given steroids.  She then started to decline and hospice nurse came and she was admitted to Hershey and they repeated her chest x-ray and COVID testing, and that her lungs were so scarred there was nothing that they could do for her.  They tested her for COVID multiple times, the CAT Scans came back that it was worsening and consistent with COVID but tested negative twice while was there.  She was then sent to Hospital and tested again and was negative, and she passed on 5/10/2021.    HOSPITAL ADMISSIONS: She was admitted to  on 4/19/21 discharged home on hospice on 5/6/21.    She was admitted to Medical Center on 5/6/21 and she died on 5/10/21 at 5:48 PM."
	"1355095-1"	"1355095-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Daughter reporting after her mother's death .  She got her vaccine and called her daughter in the afternoon around 2:00 and told her that she got it.  At 6:00 she received a VM where she said that she was having joint pain and wanted to know if she could call her doctor to get her joint pain medicine.  Later that evening her daughter told her that was why she was put on the Hydroxychloroquine and they wanted her to see the rheumatologist.  She complained of pain a lot, but she specifically asked for joint pain medicine.  On the 22nd on another VM her daughter noticed that she sounded raspy hoarse sounding and congested and had a cough.  Then subsequent messages after that the hoarseness was there that didn't go away.  Her daughter took her to the dentist on 4/15/21 and she remembered that the caregiver told her that she did not want to go to the dentist as she did not feel good.  She did not like to get out of the apartment.  Then on 4/19/21 she was admitted to the hospital and that she had pneumonia.  They were going to discharge her home and she was going to pick her up on 4/22/21, and then they called her back and told her that she sounded junky and they were going to keep her another day.  She made arrangements to pick her up on Friday and then her oxygens dropped and would discharge her on Monday.    She normally gets oxygen 1 liter of oxygen only at night, and when she was admitted her oxygen levels were low and they put her on 6 liters when she was admitted.  Then she was weaned off oxygen completely, and her daughter informed them that she slept with oxygen and that's when they were talking about going home.  On Friday she dropped her oxygen level into the 60's  On Saturday 4/24/21 she was on 9 liters of oxygen and the doctor came in and said that she was on 14.  By Saturday night she was on the Critical care Unit, but her on Vancomycin and was on Vapotherm on high-flow oxygen and she had maxed out at 40 liters at 100% oxygen.   They talked to the daughter about putting her on ventilation and thought it was toxicity to Vancomycin and other things and couldn't figure it out and said that it was some sort of inflammation of her lungs.  They put her on high levels of steroids and was then taken off of high-flow oxygen and then was still on 20% liters.  They recommended hospice and palliative care.  They decided to bring her home on Hospice with 15 liters of oxygen.  It was up and down levels.  She was given steroids when she came home on Hospice and was given steroids.  She then started to decline and hospice nurse came and she was admitted to Hershey and they repeated her chest x-ray and COVID testing, and that her lungs were so scarred there was nothing that they could do for her.  They tested her for COVID multiple times, the CAT Scans came back that it was worsening and consistent with COVID but tested negative twice while was there.  She was then sent to Hospital and tested again and was negative, and she passed on 5/10/2021.    HOSPITAL ADMISSIONS: She was admitted to  on 4/19/21 discharged home on hospice on 5/6/21.    She was admitted to Medical Center on 5/6/21 and she died on 5/10/21 at 5:48 PM."
	"1355095-1"	"1355095-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"Daughter reporting after her mother's death .  She got her vaccine and called her daughter in the afternoon around 2:00 and told her that she got it.  At 6:00 she received a VM where she said that she was having joint pain and wanted to know if she could call her doctor to get her joint pain medicine.  Later that evening her daughter told her that was why she was put on the Hydroxychloroquine and they wanted her to see the rheumatologist.  She complained of pain a lot, but she specifically asked for joint pain medicine.  On the 22nd on another VM her daughter noticed that she sounded raspy hoarse sounding and congested and had a cough.  Then subsequent messages after that the hoarseness was there that didn't go away.  Her daughter took her to the dentist on 4/15/21 and she remembered that the caregiver told her that she did not want to go to the dentist as she did not feel good.  She did not like to get out of the apartment.  Then on 4/19/21 she was admitted to the hospital and that she had pneumonia.  They were going to discharge her home and she was going to pick her up on 4/22/21, and then they called her back and told her that she sounded junky and they were going to keep her another day.  She made arrangements to pick her up on Friday and then her oxygens dropped and would discharge her on Monday.    She normally gets oxygen 1 liter of oxygen only at night, and when she was admitted her oxygen levels were low and they put her on 6 liters when she was admitted.  Then she was weaned off oxygen completely, and her daughter informed them that she slept with oxygen and that's when they were talking about going home.  On Friday she dropped her oxygen level into the 60's  On Saturday 4/24/21 she was on 9 liters of oxygen and the doctor came in and said that she was on 14.  By Saturday night she was on the Critical care Unit, but her on Vancomycin and was on Vapotherm on high-flow oxygen and she had maxed out at 40 liters at 100% oxygen.   They talked to the daughter about putting her on ventilation and thought it was toxicity to Vancomycin and other things and couldn't figure it out and said that it was some sort of inflammation of her lungs.  They put her on high levels of steroids and was then taken off of high-flow oxygen and then was still on 20% liters.  They recommended hospice and palliative care.  They decided to bring her home on Hospice with 15 liters of oxygen.  It was up and down levels.  She was given steroids when she came home on Hospice and was given steroids.  She then started to decline and hospice nurse came and she was admitted to Hershey and they repeated her chest x-ray and COVID testing, and that her lungs were so scarred there was nothing that they could do for her.  They tested her for COVID multiple times, the CAT Scans came back that it was worsening and consistent with COVID but tested negative twice while was there.  She was then sent to Hospital and tested again and was negative, and she passed on 5/10/2021.    HOSPITAL ADMISSIONS: She was admitted to  on 4/19/21 discharged home on hospice on 5/6/21.    She was admitted to Medical Center on 5/6/21 and she died on 5/10/21 at 5:48 PM."
	"1355095-1"	"1355095-1"	"PNEUMONIA"	"10035664"	"65-79 years"	"65-79"	"Daughter reporting after her mother's death .  She got her vaccine and called her daughter in the afternoon around 2:00 and told her that she got it.  At 6:00 she received a VM where she said that she was having joint pain and wanted to know if she could call her doctor to get her joint pain medicine.  Later that evening her daughter told her that was why she was put on the Hydroxychloroquine and they wanted her to see the rheumatologist.  She complained of pain a lot, but she specifically asked for joint pain medicine.  On the 22nd on another VM her daughter noticed that she sounded raspy hoarse sounding and congested and had a cough.  Then subsequent messages after that the hoarseness was there that didn't go away.  Her daughter took her to the dentist on 4/15/21 and she remembered that the caregiver told her that she did not want to go to the dentist as she did not feel good.  She did not like to get out of the apartment.  Then on 4/19/21 she was admitted to the hospital and that she had pneumonia.  They were going to discharge her home and she was going to pick her up on 4/22/21, and then they called her back and told her that she sounded junky and they were going to keep her another day.  She made arrangements to pick her up on Friday and then her oxygens dropped and would discharge her on Monday.    She normally gets oxygen 1 liter of oxygen only at night, and when she was admitted her oxygen levels were low and they put her on 6 liters when she was admitted.  Then she was weaned off oxygen completely, and her daughter informed them that she slept with oxygen and that's when they were talking about going home.  On Friday she dropped her oxygen level into the 60's  On Saturday 4/24/21 she was on 9 liters of oxygen and the doctor came in and said that she was on 14.  By Saturday night she was on the Critical care Unit, but her on Vancomycin and was on Vapotherm on high-flow oxygen and she had maxed out at 40 liters at 100% oxygen.   They talked to the daughter about putting her on ventilation and thought it was toxicity to Vancomycin and other things and couldn't figure it out and said that it was some sort of inflammation of her lungs.  They put her on high levels of steroids and was then taken off of high-flow oxygen and then was still on 20% liters.  They recommended hospice and palliative care.  They decided to bring her home on Hospice with 15 liters of oxygen.  It was up and down levels.  She was given steroids when she came home on Hospice and was given steroids.  She then started to decline and hospice nurse came and she was admitted to Hershey and they repeated her chest x-ray and COVID testing, and that her lungs were so scarred there was nothing that they could do for her.  They tested her for COVID multiple times, the CAT Scans came back that it was worsening and consistent with COVID but tested negative twice while was there.  She was then sent to Hospital and tested again and was negative, and she passed on 5/10/2021.    HOSPITAL ADMISSIONS: She was admitted to  on 4/19/21 discharged home on hospice on 5/6/21.    She was admitted to Medical Center on 5/6/21 and she died on 5/10/21 at 5:48 PM."
	"1355095-1"	"1355095-1"	"PNEUMONITIS"	"10035742"	"65-79 years"	"65-79"	"Daughter reporting after her mother's death .  She got her vaccine and called her daughter in the afternoon around 2:00 and told her that she got it.  At 6:00 she received a VM where she said that she was having joint pain and wanted to know if she could call her doctor to get her joint pain medicine.  Later that evening her daughter told her that was why she was put on the Hydroxychloroquine and they wanted her to see the rheumatologist.  She complained of pain a lot, but she specifically asked for joint pain medicine.  On the 22nd on another VM her daughter noticed that she sounded raspy hoarse sounding and congested and had a cough.  Then subsequent messages after that the hoarseness was there that didn't go away.  Her daughter took her to the dentist on 4/15/21 and she remembered that the caregiver told her that she did not want to go to the dentist as she did not feel good.  She did not like to get out of the apartment.  Then on 4/19/21 she was admitted to the hospital and that she had pneumonia.  They were going to discharge her home and she was going to pick her up on 4/22/21, and then they called her back and told her that she sounded junky and they were going to keep her another day.  She made arrangements to pick her up on Friday and then her oxygens dropped and would discharge her on Monday.    She normally gets oxygen 1 liter of oxygen only at night, and when she was admitted her oxygen levels were low and they put her on 6 liters when she was admitted.  Then she was weaned off oxygen completely, and her daughter informed them that she slept with oxygen and that's when they were talking about going home.  On Friday she dropped her oxygen level into the 60's  On Saturday 4/24/21 she was on 9 liters of oxygen and the doctor came in and said that she was on 14.  By Saturday night she was on the Critical care Unit, but her on Vancomycin and was on Vapotherm on high-flow oxygen and she had maxed out at 40 liters at 100% oxygen.   They talked to the daughter about putting her on ventilation and thought it was toxicity to Vancomycin and other things and couldn't figure it out and said that it was some sort of inflammation of her lungs.  They put her on high levels of steroids and was then taken off of high-flow oxygen and then was still on 20% liters.  They recommended hospice and palliative care.  They decided to bring her home on Hospice with 15 liters of oxygen.  It was up and down levels.  She was given steroids when she came home on Hospice and was given steroids.  She then started to decline and hospice nurse came and she was admitted to Hershey and they repeated her chest x-ray and COVID testing, and that her lungs were so scarred there was nothing that they could do for her.  They tested her for COVID multiple times, the CAT Scans came back that it was worsening and consistent with COVID but tested negative twice while was there.  She was then sent to Hospital and tested again and was negative, and she passed on 5/10/2021.    HOSPITAL ADMISSIONS: She was admitted to  on 4/19/21 discharged home on hospice on 5/6/21.    She was admitted to Medical Center on 5/6/21 and she died on 5/10/21 at 5:48 PM."
	"1355095-1"	"1355095-1"	"PULMONARY FIBROSIS"	"10037383"	"65-79 years"	"65-79"	"Daughter reporting after her mother's death .  She got her vaccine and called her daughter in the afternoon around 2:00 and told her that she got it.  At 6:00 she received a VM where she said that she was having joint pain and wanted to know if she could call her doctor to get her joint pain medicine.  Later that evening her daughter told her that was why she was put on the Hydroxychloroquine and they wanted her to see the rheumatologist.  She complained of pain a lot, but she specifically asked for joint pain medicine.  On the 22nd on another VM her daughter noticed that she sounded raspy hoarse sounding and congested and had a cough.  Then subsequent messages after that the hoarseness was there that didn't go away.  Her daughter took her to the dentist on 4/15/21 and she remembered that the caregiver told her that she did not want to go to the dentist as she did not feel good.  She did not like to get out of the apartment.  Then on 4/19/21 she was admitted to the hospital and that she had pneumonia.  They were going to discharge her home and she was going to pick her up on 4/22/21, and then they called her back and told her that she sounded junky and they were going to keep her another day.  She made arrangements to pick her up on Friday and then her oxygens dropped and would discharge her on Monday.    She normally gets oxygen 1 liter of oxygen only at night, and when she was admitted her oxygen levels were low and they put her on 6 liters when she was admitted.  Then she was weaned off oxygen completely, and her daughter informed them that she slept with oxygen and that's when they were talking about going home.  On Friday she dropped her oxygen level into the 60's  On Saturday 4/24/21 she was on 9 liters of oxygen and the doctor came in and said that she was on 14.  By Saturday night she was on the Critical care Unit, but her on Vancomycin and was on Vapotherm on high-flow oxygen and she had maxed out at 40 liters at 100% oxygen.   They talked to the daughter about putting her on ventilation and thought it was toxicity to Vancomycin and other things and couldn't figure it out and said that it was some sort of inflammation of her lungs.  They put her on high levels of steroids and was then taken off of high-flow oxygen and then was still on 20% liters.  They recommended hospice and palliative care.  They decided to bring her home on Hospice with 15 liters of oxygen.  It was up and down levels.  She was given steroids when she came home on Hospice and was given steroids.  She then started to decline and hospice nurse came and she was admitted to Hershey and they repeated her chest x-ray and COVID testing, and that her lungs were so scarred there was nothing that they could do for her.  They tested her for COVID multiple times, the CAT Scans came back that it was worsening and consistent with COVID but tested negative twice while was there.  She was then sent to Hospital and tested again and was negative, and she passed on 5/10/2021.    HOSPITAL ADMISSIONS: She was admitted to  on 4/19/21 discharged home on hospice on 5/6/21.    She was admitted to Medical Center on 5/6/21 and she died on 5/10/21 at 5:48 PM."
	"1355095-1"	"1355095-1"	"RESPIRATORY TRACT CONGESTION"	"10052251"	"65-79 years"	"65-79"	"Daughter reporting after her mother's death .  She got her vaccine and called her daughter in the afternoon around 2:00 and told her that she got it.  At 6:00 she received a VM where she said that she was having joint pain and wanted to know if she could call her doctor to get her joint pain medicine.  Later that evening her daughter told her that was why she was put on the Hydroxychloroquine and they wanted her to see the rheumatologist.  She complained of pain a lot, but she specifically asked for joint pain medicine.  On the 22nd on another VM her daughter noticed that she sounded raspy hoarse sounding and congested and had a cough.  Then subsequent messages after that the hoarseness was there that didn't go away.  Her daughter took her to the dentist on 4/15/21 and she remembered that the caregiver told her that she did not want to go to the dentist as she did not feel good.  She did not like to get out of the apartment.  Then on 4/19/21 she was admitted to the hospital and that she had pneumonia.  They were going to discharge her home and she was going to pick her up on 4/22/21, and then they called her back and told her that she sounded junky and they were going to keep her another day.  She made arrangements to pick her up on Friday and then her oxygens dropped and would discharge her on Monday.    She normally gets oxygen 1 liter of oxygen only at night, and when she was admitted her oxygen levels were low and they put her on 6 liters when she was admitted.  Then she was weaned off oxygen completely, and her daughter informed them that she slept with oxygen and that's when they were talking about going home.  On Friday she dropped her oxygen level into the 60's  On Saturday 4/24/21 she was on 9 liters of oxygen and the doctor came in and said that she was on 14.  By Saturday night she was on the Critical care Unit, but her on Vancomycin and was on Vapotherm on high-flow oxygen and she had maxed out at 40 liters at 100% oxygen.   They talked to the daughter about putting her on ventilation and thought it was toxicity to Vancomycin and other things and couldn't figure it out and said that it was some sort of inflammation of her lungs.  They put her on high levels of steroids and was then taken off of high-flow oxygen and then was still on 20% liters.  They recommended hospice and palliative care.  They decided to bring her home on Hospice with 15 liters of oxygen.  It was up and down levels.  She was given steroids when she came home on Hospice and was given steroids.  She then started to decline and hospice nurse came and she was admitted to Hershey and they repeated her chest x-ray and COVID testing, and that her lungs were so scarred there was nothing that they could do for her.  They tested her for COVID multiple times, the CAT Scans came back that it was worsening and consistent with COVID but tested negative twice while was there.  She was then sent to Hospital and tested again and was negative, and she passed on 5/10/2021.    HOSPITAL ADMISSIONS: She was admitted to  on 4/19/21 discharged home on hospice on 5/6/21.    She was admitted to Medical Center on 5/6/21 and she died on 5/10/21 at 5:48 PM."
	"1355095-1"	"1355095-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	"Daughter reporting after her mother's death .  She got her vaccine and called her daughter in the afternoon around 2:00 and told her that she got it.  At 6:00 she received a VM where she said that she was having joint pain and wanted to know if she could call her doctor to get her joint pain medicine.  Later that evening her daughter told her that was why she was put on the Hydroxychloroquine and they wanted her to see the rheumatologist.  She complained of pain a lot, but she specifically asked for joint pain medicine.  On the 22nd on another VM her daughter noticed that she sounded raspy hoarse sounding and congested and had a cough.  Then subsequent messages after that the hoarseness was there that didn't go away.  Her daughter took her to the dentist on 4/15/21 and she remembered that the caregiver told her that she did not want to go to the dentist as she did not feel good.  She did not like to get out of the apartment.  Then on 4/19/21 she was admitted to the hospital and that she had pneumonia.  They were going to discharge her home and she was going to pick her up on 4/22/21, and then they called her back and told her that she sounded junky and they were going to keep her another day.  She made arrangements to pick her up on Friday and then her oxygens dropped and would discharge her on Monday.    She normally gets oxygen 1 liter of oxygen only at night, and when she was admitted her oxygen levels were low and they put her on 6 liters when she was admitted.  Then she was weaned off oxygen completely, and her daughter informed them that she slept with oxygen and that's when they were talking about going home.  On Friday she dropped her oxygen level into the 60's  On Saturday 4/24/21 she was on 9 liters of oxygen and the doctor came in and said that she was on 14.  By Saturday night she was on the Critical care Unit, but her on Vancomycin and was on Vapotherm on high-flow oxygen and she had maxed out at 40 liters at 100% oxygen.   They talked to the daughter about putting her on ventilation and thought it was toxicity to Vancomycin and other things and couldn't figure it out and said that it was some sort of inflammation of her lungs.  They put her on high levels of steroids and was then taken off of high-flow oxygen and then was still on 20% liters.  They recommended hospice and palliative care.  They decided to bring her home on Hospice with 15 liters of oxygen.  It was up and down levels.  She was given steroids when she came home on Hospice and was given steroids.  She then started to decline and hospice nurse came and she was admitted to Hershey and they repeated her chest x-ray and COVID testing, and that her lungs were so scarred there was nothing that they could do for her.  They tested her for COVID multiple times, the CAT Scans came back that it was worsening and consistent with COVID but tested negative twice while was there.  She was then sent to Hospital and tested again and was negative, and she passed on 5/10/2021.    HOSPITAL ADMISSIONS: She was admitted to  on 4/19/21 discharged home on hospice on 5/6/21.    She was admitted to Medical Center on 5/6/21 and she died on 5/10/21 at 5:48 PM."
	"1355384-1"	"1355384-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Admitted to the hospital with weakness, fever on 4/14/2021. Transferred to ICU on 4/17/21 requiring bipap. Intubated 4/25/2021. covid + 4/2/21. Last vaccine dose completed 3/3/2021. Pt died on 5/15/2021"
	"1355384-1"	"1355384-1"	"BILEVEL POSITIVE AIRWAY PRESSURE"	"10064530"	"65-79 years"	"65-79"	"Admitted to the hospital with weakness, fever on 4/14/2021. Transferred to ICU on 4/17/21 requiring bipap. Intubated 4/25/2021. covid + 4/2/21. Last vaccine dose completed 3/3/2021. Pt died on 5/15/2021"
	"1355384-1"	"1355384-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Admitted to the hospital with weakness, fever on 4/14/2021. Transferred to ICU on 4/17/21 requiring bipap. Intubated 4/25/2021. covid + 4/2/21. Last vaccine dose completed 3/3/2021. Pt died on 5/15/2021"
	"1355384-1"	"1355384-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Admitted to the hospital with weakness, fever on 4/14/2021. Transferred to ICU on 4/17/21 requiring bipap. Intubated 4/25/2021. covid + 4/2/21. Last vaccine dose completed 3/3/2021. Pt died on 5/15/2021"
	"1355384-1"	"1355384-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Admitted to the hospital with weakness, fever on 4/14/2021. Transferred to ICU on 4/17/21 requiring bipap. Intubated 4/25/2021. covid + 4/2/21. Last vaccine dose completed 3/3/2021. Pt died on 5/15/2021"
	"1355384-1"	"1355384-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Admitted to the hospital with weakness, fever on 4/14/2021. Transferred to ICU on 4/17/21 requiring bipap. Intubated 4/25/2021. covid + 4/2/21. Last vaccine dose completed 3/3/2021. Pt died on 5/15/2021"
	"1355384-1"	"1355384-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"Admitted to the hospital with weakness, fever on 4/14/2021. Transferred to ICU on 4/17/21 requiring bipap. Intubated 4/25/2021. covid + 4/2/21. Last vaccine dose completed 3/3/2021. Pt died on 5/15/2021"
	"1355384-1"	"1355384-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Admitted to the hospital with weakness, fever on 4/14/2021. Transferred to ICU on 4/17/21 requiring bipap. Intubated 4/25/2021. covid + 4/2/21. Last vaccine dose completed 3/3/2021. Pt died on 5/15/2021"
	"1358044-1"	"1358044-1"	"APHASIA"	"10002948"	"65-79 years"	"65-79"	"Resident was not having any complaints after injection, Vitals were being monitored Q-shift for 72 hours and up to the time of incident vitals were stable, Administrator received phone call approximately 120am stating resident was complaining of SOB and Chest pain, RN supervisor came to assess resident and determined that she needed to be sent out. EMS was called and in route and resident was having conversation with night shift staff member and suddenly ceased talking and had passed away. Resident was a DNR at the time of incident."
	"1358044-1"	"1358044-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	"Resident was not having any complaints after injection, Vitals were being monitored Q-shift for 72 hours and up to the time of incident vitals were stable, Administrator received phone call approximately 120am stating resident was complaining of SOB and Chest pain, RN supervisor came to assess resident and determined that she needed to be sent out. EMS was called and in route and resident was having conversation with night shift staff member and suddenly ceased talking and had passed away. Resident was a DNR at the time of incident."
	"1358044-1"	"1358044-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Resident was not having any complaints after injection, Vitals were being monitored Q-shift for 72 hours and up to the time of incident vitals were stable, Administrator received phone call approximately 120am stating resident was complaining of SOB and Chest pain, RN supervisor came to assess resident and determined that she needed to be sent out. EMS was called and in route and resident was having conversation with night shift staff member and suddenly ceased talking and had passed away. Resident was a DNR at the time of incident."
	"1358044-1"	"1358044-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Resident was not having any complaints after injection, Vitals were being monitored Q-shift for 72 hours and up to the time of incident vitals were stable, Administrator received phone call approximately 120am stating resident was complaining of SOB and Chest pain, RN supervisor came to assess resident and determined that she needed to be sent out. EMS was called and in route and resident was having conversation with night shift staff member and suddenly ceased talking and had passed away. Resident was a DNR at the time of incident."
	"1362465-1"	"1362465-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	"chest pain, fatigue, death"
	"1362465-1"	"1362465-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"chest pain, fatigue, death"
	"1362465-1"	"1362465-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"chest pain, fatigue, death"
	"1389821-1"	"1389821-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death"
	"1413046-1"	"1413046-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Sudden cardiac arrest 3 days after second vaccine"
	"1413046-1"	"1413046-1"	"SUDDEN DEATH"	"10042434"	"65-79 years"	"65-79"	"Sudden cardiac arrest 3 days after second vaccine"
	"1414492-1"	"1414492-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"ADENOVIRUS TEST"	"10050991"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"ANGIOGRAM CEREBRAL NORMAL"	"10052907"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"ARTERIOGRAM CAROTID NORMAL"	"10003196"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"BORDETELLA TEST NEGATIVE"	"10070278"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"COMPUTERISED TOMOGRAM HEAD NORMAL"	"10072167"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"COMPUTERISED TOMOGRAM THORAX ABNORMAL"	"10057799"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"DECREASED APPETITE"	"10061428"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"ECHOCARDIOGRAM"	"10014113"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"ECHOCARDIOGRAM ABNORMAL"	"10061593"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"EJECTION FRACTION DECREASED"	"10050528"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"ENTEROVIRUS TEST NEGATIVE"	"10070397"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"EXPOSURE TO SARS-COV-2"	"10084456"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"HUMAN METAPNEUMOVIRUS TEST"	"10072858"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"HUMAN RHINOVIRUS TEST"	"10075163"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"INFLUENZA A VIRUS TEST NEGATIVE"	"10070417"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"INFLUENZA B VIRUS TEST"	"10071544"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"INFLUENZA VIRUS TEST NEGATIVE"	"10070718"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"MYCOPLASMA TEST NEGATIVE"	"10078590"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"RESPIRATORY SYNCYTIAL VIRUS TEST NEGATIVE"	"10068564"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"RESPIRATORY VIRAL PANEL"	"10075165"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"RESPIROVIRUS TEST"	"10075548"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"SCAN WITH CONTRAST"	"10059696"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"SEIZURE"	"10039906"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1414492-1"	"1414492-1"	"VIRAL TEST NEGATIVE"	"10062362"	"65-79 years"	"65-79"	"Nursing Home Visit 6/2/2021  Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today.  She has been complaining of sinus congestion for past 3 to 4 days.  Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her.  Unfortunately she also tested positive for COVID-19.  She has received full dose of COVID-19 vaccine earlier in February.  She denies any fever or chills.  She denies any shortness of breath.  She does complain of cough and sinus congestion going on for a week or so.     Chief complaint: Acute hypoxic respiratory failure due to COVID-19   SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday.  She has been complaining of sinus congestion for the past for 5 days.  However this has been at her baseline.  She has multiple allergies and taking antihistamine chronically.  There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19.  She also tested positive for COVID-19 yesterday.  Unfortunately this morning she declined and needed oxygen support.  Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2.  She was not using any accessory muscle.  She did complain of mild cough but denied any chest pain.  Her appetite is poor.  She does not look toxic.  Date: 6/3/2021 Admission Date: 6/3/2021   Assessments     Patient is a 74 y.o. female on hospital day number 0    Medical Problems     Hospital Problems        POA   * (Principal) Pneumonia due to COVID-19 virus Yes                    Plan     Chief Complaint Patient presents with ? Shortness of Breath     #.  COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy.  Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history.  She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula.   #.  Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin.   #.  Essential hypertension -Patient continues on various antihypertensive medication.   #.  Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital.     Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible.   History of Present Illness     Patient is an 74 y.o. female.    Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis.  Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic.  Patient has been complaining of sinus congestion over the past 5 to 7 days.  According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19.  Patient had a Covid test done yesterday and she was COVID-19 positive.  Patient respiratory status declined.  Patient required oxygen support.  Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula.  Patient had not been using accessory muscles.  Patient also reports occasional cough and has yellowish phlegm production.  Patient was referred to Hospital emergency department for further evaluation and treatment.   ED to Hosp-Admission Discharged  6/3/2021 - 6/14/2021 (11 days)  Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  Principal problem  DETAILS OF HOSPITAL STAY   Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus  Acute respiratory failure  Hospital Course   Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment.  Patient with recent diagnosis of osteomyelitis and on antibiotics per ID.  She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway.  Patient had further decline of her respiratory status. She did pass SBT's and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning."
	"1415368-1"	"1415368-1"	"AUTOPSY"	"10050117"	"65-79 years"	"65-79"	"Patient died of a sudden heart attack at age 70, just 2 months after receiving his 2nd dose of the vaccine. His parents lived well into their mid-eighties and patient spent the last 17 years of his working years as a door to door, getting lots of cardio exercise every day. At the time of his death he was a very low stress person and taking good care of himself."
	"1415368-1"	"1415368-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient died of a sudden heart attack at age 70, just 2 months after receiving his 2nd dose of the vaccine. His parents lived well into their mid-eighties and patient spent the last 17 years of his working years as a door to door, getting lots of cardio exercise every day. At the time of his death he was a very low stress person and taking good care of himself."
	"1415368-1"	"1415368-1"	"MYOCARDIAL INFARCTION"	"10028596"	"65-79 years"	"65-79"	"Patient died of a sudden heart attack at age 70, just 2 months after receiving his 2nd dose of the vaccine. His parents lived well into their mid-eighties and patient spent the last 17 years of his working years as a door to door, getting lots of cardio exercise every day. At the time of his death he was a very low stress person and taking good care of himself."
	"1417063-1"	"1417063-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient passed away on 6/20/2021.  Cause of death unknown."
	"1417175-1"	"1417175-1"	"MYOCARDIAL INFARCTION"	"10028596"	"65-79 years"	"65-79"	"Massive Heart Attack"
	"1429777-1"	"1429777-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Found dead 9 days after vaccine"
	"1431331-1"	"1431331-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Patient received second COVID vaccine on 2/3/2021. Was admitted to Medical Center on 6/15/21 for generalized weakness and tested positive for COVID 19 on 6/15/2021. Patient was also positive for COVID 19 in November 2020. Patient expired on 6/26/2021 while hospitalized."
	"1431331-1"	"1431331-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient received second COVID vaccine on 2/3/2021. Was admitted to Medical Center on 6/15/21 for generalized weakness and tested positive for COVID 19 on 6/15/2021. Patient was also positive for COVID 19 in November 2020. Patient expired on 6/26/2021 while hospitalized."
	"1431331-1"	"1431331-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received second COVID vaccine on 2/3/2021. Was admitted to Medical Center on 6/15/21 for generalized weakness and tested positive for COVID 19 on 6/15/2021. Patient was also positive for COVID 19 in November 2020. Patient expired on 6/26/2021 while hospitalized."
	"1431331-1"	"1431331-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient received second COVID vaccine on 2/3/2021. Was admitted to Medical Center on 6/15/21 for generalized weakness and tested positive for COVID 19 on 6/15/2021. Patient was also positive for COVID 19 in November 2020. Patient expired on 6/26/2021 while hospitalized."
	"1437580-1"	"1437580-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Was found on the floor, snoring with foam forming out of his mouth. Was sent to the emergency room suffered a heart attack, passed away June 21, 2021."
	"1437580-1"	"1437580-1"	"FOAMING AT MOUTH"	"10062654"	"65-79 years"	"65-79"	"Was found on the floor, snoring with foam forming out of his mouth. Was sent to the emergency room suffered a heart attack, passed away June 21, 2021."
	"1437580-1"	"1437580-1"	"MYOCARDIAL INFARCTION"	"10028596"	"65-79 years"	"65-79"	"Was found on the floor, snoring with foam forming out of his mouth. Was sent to the emergency room suffered a heart attack, passed away June 21, 2021."
	"1437580-1"	"1437580-1"	"SNORING"	"10041235"	"65-79 years"	"65-79"	"Was found on the floor, snoring with foam forming out of his mouth. Was sent to the emergency room suffered a heart attack, passed away June 21, 2021."
	"1441060-1"	"1441060-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Blood clots in heart with extremely low blood pressure and shortness of breath. Symptoms suddenly appeared on 04/02/21. Hospitalization and rehabilitation Until discharge of 05/03/2021.  Extremely low blood pressure, weakness and shortness of breath continued until he was hospitalized again 06/02/2021 He passed away 06/09/2021. He was labeled as Covid 19"
	"1441060-1"	"1441060-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Blood clots in heart with extremely low blood pressure and shortness of breath. Symptoms suddenly appeared on 04/02/21. Hospitalization and rehabilitation Until discharge of 05/03/2021.  Extremely low blood pressure, weakness and shortness of breath continued until he was hospitalized again 06/02/2021 He passed away 06/09/2021. He was labeled as Covid 19"
	"1441060-1"	"1441060-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Blood clots in heart with extremely low blood pressure and shortness of breath. Symptoms suddenly appeared on 04/02/21. Hospitalization and rehabilitation Until discharge of 05/03/2021.  Extremely low blood pressure, weakness and shortness of breath continued until he was hospitalized again 06/02/2021 He passed away 06/09/2021. He was labeled as Covid 19"
	"1441060-1"	"1441060-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Blood clots in heart with extremely low blood pressure and shortness of breath. Symptoms suddenly appeared on 04/02/21. Hospitalization and rehabilitation Until discharge of 05/03/2021.  Extremely low blood pressure, weakness and shortness of breath continued until he was hospitalized again 06/02/2021 He passed away 06/09/2021. He was labeled as Covid 19"
	"1441060-1"	"1441060-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	"Blood clots in heart with extremely low blood pressure and shortness of breath. Symptoms suddenly appeared on 04/02/21. Hospitalization and rehabilitation Until discharge of 05/03/2021.  Extremely low blood pressure, weakness and shortness of breath continued until he was hospitalized again 06/02/2021 He passed away 06/09/2021. He was labeled as Covid 19"
	"1441060-1"	"1441060-1"	"THROMBOSIS"	"10043607"	"65-79 years"	"65-79"	"Blood clots in heart with extremely low blood pressure and shortness of breath. Symptoms suddenly appeared on 04/02/21. Hospitalization and rehabilitation Until discharge of 05/03/2021.  Extremely low blood pressure, weakness and shortness of breath continued until he was hospitalized again 06/02/2021 He passed away 06/09/2021. He was labeled as Covid 19"
	"1449786-1"	"1449786-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"chest hurt; pulmonary issues; heart failure; kidney failure; Cardiac arrest; flu like symptoms; tingling in arms and feet; rashes in the body; itchy; weakness to the point that she could not walk; passed away; cardiac arrest; hurting arm; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away), CARDIAC ARREST (cardiac arrest), CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), CARDIAC ARREST (Cardiac arrest), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039B21A and 038A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.   On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 21-Apr-2021, the patient experienced INFLUENZA LIKE ILLNESS (flu like symptoms) (seriousness criterion hospitalization), PARAESTHESIA (tingling in arms and feet) (seriousness criterion hospitalization), RASH (rashes in the body) (seriousness criterion hospitalization), PRURITUS (itchy) (seriousness criterion hospitalization) and ASTHENIA (weakness to the point that she could not walk) (seriousness criterion hospitalization). 21-Apr-2021, the patient experienced PAIN IN EXTREMITY (hurting arm). On 27-May-2021, the patient experienced CARDIAC FAILURE (heart failure) (seriousness criteria hospitalization and medically significant), RENAL FAILURE (kidney failure) (seriousness criteria hospitalization and medically significant), CARDIAC ARREST (Cardiac arrest) (seriousness criteria hospitalization prolonged and medically significant) and LUNG DISORDER (pulmonary issues) (seriousness criterion hospitalization). On 05-Jun-2021, the patient experienced CHEST PAIN (chest hurt) (seriousness criterion hospitalization). On 14-Jun-2021, the patient experienced CARDIAC ARREST (cardiac arrest) (seriousness criteria death and medically significant). On 27-May-2021, CARDIAC ARREST (Cardiac arrest) had resolved. The patient died on 14-Jun-2021. The reported cause of death was Cardiac arrest. It is unknown if an autopsy was performed. At the time of death, CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) outcome was unknown and PAIN IN EXTREMITY (hurting arm) had resolved.            No relevant medical history was reported. No concomitant medication provided. The patient was having respiratory problem few days  after the 2nd dose along with other issues. She was administered with asthma medicines. The name was not specified. Action taken with mRNA-1273 in response to the events was not Applicable.  Very limited information regarding this events has been provided at this time.  Further information has been requested.; Sender's Comments: Very limited information regarding this events has been provided at this time.  Further information has been requested.; Reported Cause(s) of Death: cardiac arrest"
	"1449786-1"	"1449786-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"chest hurt; pulmonary issues; heart failure; kidney failure; Cardiac arrest; flu like symptoms; tingling in arms and feet; rashes in the body; itchy; weakness to the point that she could not walk; passed away; cardiac arrest; hurting arm; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away), CARDIAC ARREST (cardiac arrest), CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), CARDIAC ARREST (Cardiac arrest), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039B21A and 038A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.   On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 21-Apr-2021, the patient experienced INFLUENZA LIKE ILLNESS (flu like symptoms) (seriousness criterion hospitalization), PARAESTHESIA (tingling in arms and feet) (seriousness criterion hospitalization), RASH (rashes in the body) (seriousness criterion hospitalization), PRURITUS (itchy) (seriousness criterion hospitalization) and ASTHENIA (weakness to the point that she could not walk) (seriousness criterion hospitalization). 21-Apr-2021, the patient experienced PAIN IN EXTREMITY (hurting arm). On 27-May-2021, the patient experienced CARDIAC FAILURE (heart failure) (seriousness criteria hospitalization and medically significant), RENAL FAILURE (kidney failure) (seriousness criteria hospitalization and medically significant), CARDIAC ARREST (Cardiac arrest) (seriousness criteria hospitalization prolonged and medically significant) and LUNG DISORDER (pulmonary issues) (seriousness criterion hospitalization). On 05-Jun-2021, the patient experienced CHEST PAIN (chest hurt) (seriousness criterion hospitalization). On 14-Jun-2021, the patient experienced CARDIAC ARREST (cardiac arrest) (seriousness criteria death and medically significant). On 27-May-2021, CARDIAC ARREST (Cardiac arrest) had resolved. The patient died on 14-Jun-2021. The reported cause of death was Cardiac arrest. It is unknown if an autopsy was performed. At the time of death, CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) outcome was unknown and PAIN IN EXTREMITY (hurting arm) had resolved.            No relevant medical history was reported. No concomitant medication provided. The patient was having respiratory problem few days  after the 2nd dose along with other issues. She was administered with asthma medicines. The name was not specified. Action taken with mRNA-1273 in response to the events was not Applicable.  Very limited information regarding this events has been provided at this time.  Further information has been requested.; Sender's Comments: Very limited information regarding this events has been provided at this time.  Further information has been requested.; Reported Cause(s) of Death: cardiac arrest"
	"1449786-1"	"1449786-1"	"CARDIAC FAILURE"	"10007554"	"65-79 years"	"65-79"	"chest hurt; pulmonary issues; heart failure; kidney failure; Cardiac arrest; flu like symptoms; tingling in arms and feet; rashes in the body; itchy; weakness to the point that she could not walk; passed away; cardiac arrest; hurting arm; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away), CARDIAC ARREST (cardiac arrest), CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), CARDIAC ARREST (Cardiac arrest), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039B21A and 038A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.   On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 21-Apr-2021, the patient experienced INFLUENZA LIKE ILLNESS (flu like symptoms) (seriousness criterion hospitalization), PARAESTHESIA (tingling in arms and feet) (seriousness criterion hospitalization), RASH (rashes in the body) (seriousness criterion hospitalization), PRURITUS (itchy) (seriousness criterion hospitalization) and ASTHENIA (weakness to the point that she could not walk) (seriousness criterion hospitalization). 21-Apr-2021, the patient experienced PAIN IN EXTREMITY (hurting arm). On 27-May-2021, the patient experienced CARDIAC FAILURE (heart failure) (seriousness criteria hospitalization and medically significant), RENAL FAILURE (kidney failure) (seriousness criteria hospitalization and medically significant), CARDIAC ARREST (Cardiac arrest) (seriousness criteria hospitalization prolonged and medically significant) and LUNG DISORDER (pulmonary issues) (seriousness criterion hospitalization). On 05-Jun-2021, the patient experienced CHEST PAIN (chest hurt) (seriousness criterion hospitalization). On 14-Jun-2021, the patient experienced CARDIAC ARREST (cardiac arrest) (seriousness criteria death and medically significant). On 27-May-2021, CARDIAC ARREST (Cardiac arrest) had resolved. The patient died on 14-Jun-2021. The reported cause of death was Cardiac arrest. It is unknown if an autopsy was performed. At the time of death, CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) outcome was unknown and PAIN IN EXTREMITY (hurting arm) had resolved.            No relevant medical history was reported. No concomitant medication provided. The patient was having respiratory problem few days  after the 2nd dose along with other issues. She was administered with asthma medicines. The name was not specified. Action taken with mRNA-1273 in response to the events was not Applicable.  Very limited information regarding this events has been provided at this time.  Further information has been requested.; Sender's Comments: Very limited information regarding this events has been provided at this time.  Further information has been requested.; Reported Cause(s) of Death: cardiac arrest"
	"1449786-1"	"1449786-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	"chest hurt; pulmonary issues; heart failure; kidney failure; Cardiac arrest; flu like symptoms; tingling in arms and feet; rashes in the body; itchy; weakness to the point that she could not walk; passed away; cardiac arrest; hurting arm; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away), CARDIAC ARREST (cardiac arrest), CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), CARDIAC ARREST (Cardiac arrest), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039B21A and 038A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.   On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 21-Apr-2021, the patient experienced INFLUENZA LIKE ILLNESS (flu like symptoms) (seriousness criterion hospitalization), PARAESTHESIA (tingling in arms and feet) (seriousness criterion hospitalization), RASH (rashes in the body) (seriousness criterion hospitalization), PRURITUS (itchy) (seriousness criterion hospitalization) and ASTHENIA (weakness to the point that she could not walk) (seriousness criterion hospitalization). 21-Apr-2021, the patient experienced PAIN IN EXTREMITY (hurting arm). On 27-May-2021, the patient experienced CARDIAC FAILURE (heart failure) (seriousness criteria hospitalization and medically significant), RENAL FAILURE (kidney failure) (seriousness criteria hospitalization and medically significant), CARDIAC ARREST (Cardiac arrest) (seriousness criteria hospitalization prolonged and medically significant) and LUNG DISORDER (pulmonary issues) (seriousness criterion hospitalization). On 05-Jun-2021, the patient experienced CHEST PAIN (chest hurt) (seriousness criterion hospitalization). On 14-Jun-2021, the patient experienced CARDIAC ARREST (cardiac arrest) (seriousness criteria death and medically significant). On 27-May-2021, CARDIAC ARREST (Cardiac arrest) had resolved. The patient died on 14-Jun-2021. The reported cause of death was Cardiac arrest. It is unknown if an autopsy was performed. At the time of death, CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) outcome was unknown and PAIN IN EXTREMITY (hurting arm) had resolved.            No relevant medical history was reported. No concomitant medication provided. The patient was having respiratory problem few days  after the 2nd dose along with other issues. She was administered with asthma medicines. The name was not specified. Action taken with mRNA-1273 in response to the events was not Applicable.  Very limited information regarding this events has been provided at this time.  Further information has been requested.; Sender's Comments: Very limited information regarding this events has been provided at this time.  Further information has been requested.; Reported Cause(s) of Death: cardiac arrest"
	"1449786-1"	"1449786-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"chest hurt; pulmonary issues; heart failure; kidney failure; Cardiac arrest; flu like symptoms; tingling in arms and feet; rashes in the body; itchy; weakness to the point that she could not walk; passed away; cardiac arrest; hurting arm; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away), CARDIAC ARREST (cardiac arrest), CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), CARDIAC ARREST (Cardiac arrest), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039B21A and 038A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.   On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 21-Apr-2021, the patient experienced INFLUENZA LIKE ILLNESS (flu like symptoms) (seriousness criterion hospitalization), PARAESTHESIA (tingling in arms and feet) (seriousness criterion hospitalization), RASH (rashes in the body) (seriousness criterion hospitalization), PRURITUS (itchy) (seriousness criterion hospitalization) and ASTHENIA (weakness to the point that she could not walk) (seriousness criterion hospitalization). 21-Apr-2021, the patient experienced PAIN IN EXTREMITY (hurting arm). On 27-May-2021, the patient experienced CARDIAC FAILURE (heart failure) (seriousness criteria hospitalization and medically significant), RENAL FAILURE (kidney failure) (seriousness criteria hospitalization and medically significant), CARDIAC ARREST (Cardiac arrest) (seriousness criteria hospitalization prolonged and medically significant) and LUNG DISORDER (pulmonary issues) (seriousness criterion hospitalization). On 05-Jun-2021, the patient experienced CHEST PAIN (chest hurt) (seriousness criterion hospitalization). On 14-Jun-2021, the patient experienced CARDIAC ARREST (cardiac arrest) (seriousness criteria death and medically significant). On 27-May-2021, CARDIAC ARREST (Cardiac arrest) had resolved. The patient died on 14-Jun-2021. The reported cause of death was Cardiac arrest. It is unknown if an autopsy was performed. At the time of death, CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) outcome was unknown and PAIN IN EXTREMITY (hurting arm) had resolved.            No relevant medical history was reported. No concomitant medication provided. The patient was having respiratory problem few days  after the 2nd dose along with other issues. She was administered with asthma medicines. The name was not specified. Action taken with mRNA-1273 in response to the events was not Applicable.  Very limited information regarding this events has been provided at this time.  Further information has been requested.; Sender's Comments: Very limited information regarding this events has been provided at this time.  Further information has been requested.; Reported Cause(s) of Death: cardiac arrest"
	"1449786-1"	"1449786-1"	"INFLUENZA LIKE ILLNESS"	"10022004"	"65-79 years"	"65-79"	"chest hurt; pulmonary issues; heart failure; kidney failure; Cardiac arrest; flu like symptoms; tingling in arms and feet; rashes in the body; itchy; weakness to the point that she could not walk; passed away; cardiac arrest; hurting arm; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away), CARDIAC ARREST (cardiac arrest), CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), CARDIAC ARREST (Cardiac arrest), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039B21A and 038A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.   On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 21-Apr-2021, the patient experienced INFLUENZA LIKE ILLNESS (flu like symptoms) (seriousness criterion hospitalization), PARAESTHESIA (tingling in arms and feet) (seriousness criterion hospitalization), RASH (rashes in the body) (seriousness criterion hospitalization), PRURITUS (itchy) (seriousness criterion hospitalization) and ASTHENIA (weakness to the point that she could not walk) (seriousness criterion hospitalization). 21-Apr-2021, the patient experienced PAIN IN EXTREMITY (hurting arm). On 27-May-2021, the patient experienced CARDIAC FAILURE (heart failure) (seriousness criteria hospitalization and medically significant), RENAL FAILURE (kidney failure) (seriousness criteria hospitalization and medically significant), CARDIAC ARREST (Cardiac arrest) (seriousness criteria hospitalization prolonged and medically significant) and LUNG DISORDER (pulmonary issues) (seriousness criterion hospitalization). On 05-Jun-2021, the patient experienced CHEST PAIN (chest hurt) (seriousness criterion hospitalization). On 14-Jun-2021, the patient experienced CARDIAC ARREST (cardiac arrest) (seriousness criteria death and medically significant). On 27-May-2021, CARDIAC ARREST (Cardiac arrest) had resolved. The patient died on 14-Jun-2021. The reported cause of death was Cardiac arrest. It is unknown if an autopsy was performed. At the time of death, CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) outcome was unknown and PAIN IN EXTREMITY (hurting arm) had resolved.            No relevant medical history was reported. No concomitant medication provided. The patient was having respiratory problem few days  after the 2nd dose along with other issues. She was administered with asthma medicines. The name was not specified. Action taken with mRNA-1273 in response to the events was not Applicable.  Very limited information regarding this events has been provided at this time.  Further information has been requested.; Sender's Comments: Very limited information regarding this events has been provided at this time.  Further information has been requested.; Reported Cause(s) of Death: cardiac arrest"
	"1449786-1"	"1449786-1"	"LUNG DISORDER"	"10025082"	"65-79 years"	"65-79"	"chest hurt; pulmonary issues; heart failure; kidney failure; Cardiac arrest; flu like symptoms; tingling in arms and feet; rashes in the body; itchy; weakness to the point that she could not walk; passed away; cardiac arrest; hurting arm; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away), CARDIAC ARREST (cardiac arrest), CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), CARDIAC ARREST (Cardiac arrest), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039B21A and 038A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.   On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 21-Apr-2021, the patient experienced INFLUENZA LIKE ILLNESS (flu like symptoms) (seriousness criterion hospitalization), PARAESTHESIA (tingling in arms and feet) (seriousness criterion hospitalization), RASH (rashes in the body) (seriousness criterion hospitalization), PRURITUS (itchy) (seriousness criterion hospitalization) and ASTHENIA (weakness to the point that she could not walk) (seriousness criterion hospitalization). 21-Apr-2021, the patient experienced PAIN IN EXTREMITY (hurting arm). On 27-May-2021, the patient experienced CARDIAC FAILURE (heart failure) (seriousness criteria hospitalization and medically significant), RENAL FAILURE (kidney failure) (seriousness criteria hospitalization and medically significant), CARDIAC ARREST (Cardiac arrest) (seriousness criteria hospitalization prolonged and medically significant) and LUNG DISORDER (pulmonary issues) (seriousness criterion hospitalization). On 05-Jun-2021, the patient experienced CHEST PAIN (chest hurt) (seriousness criterion hospitalization). On 14-Jun-2021, the patient experienced CARDIAC ARREST (cardiac arrest) (seriousness criteria death and medically significant). On 27-May-2021, CARDIAC ARREST (Cardiac arrest) had resolved. The patient died on 14-Jun-2021. The reported cause of death was Cardiac arrest. It is unknown if an autopsy was performed. At the time of death, CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) outcome was unknown and PAIN IN EXTREMITY (hurting arm) had resolved.            No relevant medical history was reported. No concomitant medication provided. The patient was having respiratory problem few days  after the 2nd dose along with other issues. She was administered with asthma medicines. The name was not specified. Action taken with mRNA-1273 in response to the events was not Applicable.  Very limited information regarding this events has been provided at this time.  Further information has been requested.; Sender's Comments: Very limited information regarding this events has been provided at this time.  Further information has been requested.; Reported Cause(s) of Death: cardiac arrest"
	"1449786-1"	"1449786-1"	"PAIN IN EXTREMITY"	"10033425"	"65-79 years"	"65-79"	"chest hurt; pulmonary issues; heart failure; kidney failure; Cardiac arrest; flu like symptoms; tingling in arms and feet; rashes in the body; itchy; weakness to the point that she could not walk; passed away; cardiac arrest; hurting arm; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away), CARDIAC ARREST (cardiac arrest), CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), CARDIAC ARREST (Cardiac arrest), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039B21A and 038A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.   On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 21-Apr-2021, the patient experienced INFLUENZA LIKE ILLNESS (flu like symptoms) (seriousness criterion hospitalization), PARAESTHESIA (tingling in arms and feet) (seriousness criterion hospitalization), RASH (rashes in the body) (seriousness criterion hospitalization), PRURITUS (itchy) (seriousness criterion hospitalization) and ASTHENIA (weakness to the point that she could not walk) (seriousness criterion hospitalization). 21-Apr-2021, the patient experienced PAIN IN EXTREMITY (hurting arm). On 27-May-2021, the patient experienced CARDIAC FAILURE (heart failure) (seriousness criteria hospitalization and medically significant), RENAL FAILURE (kidney failure) (seriousness criteria hospitalization and medically significant), CARDIAC ARREST (Cardiac arrest) (seriousness criteria hospitalization prolonged and medically significant) and LUNG DISORDER (pulmonary issues) (seriousness criterion hospitalization). On 05-Jun-2021, the patient experienced CHEST PAIN (chest hurt) (seriousness criterion hospitalization). On 14-Jun-2021, the patient experienced CARDIAC ARREST (cardiac arrest) (seriousness criteria death and medically significant). On 27-May-2021, CARDIAC ARREST (Cardiac arrest) had resolved. The patient died on 14-Jun-2021. The reported cause of death was Cardiac arrest. It is unknown if an autopsy was performed. At the time of death, CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) outcome was unknown and PAIN IN EXTREMITY (hurting arm) had resolved.            No relevant medical history was reported. No concomitant medication provided. The patient was having respiratory problem few days  after the 2nd dose along with other issues. She was administered with asthma medicines. The name was not specified. Action taken with mRNA-1273 in response to the events was not Applicable.  Very limited information regarding this events has been provided at this time.  Further information has been requested.; Sender's Comments: Very limited information regarding this events has been provided at this time.  Further information has been requested.; Reported Cause(s) of Death: cardiac arrest"
	"1449786-1"	"1449786-1"	"PARAESTHESIA"	"10033775"	"65-79 years"	"65-79"	"chest hurt; pulmonary issues; heart failure; kidney failure; Cardiac arrest; flu like symptoms; tingling in arms and feet; rashes in the body; itchy; weakness to the point that she could not walk; passed away; cardiac arrest; hurting arm; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away), CARDIAC ARREST (cardiac arrest), CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), CARDIAC ARREST (Cardiac arrest), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039B21A and 038A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.   On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 21-Apr-2021, the patient experienced INFLUENZA LIKE ILLNESS (flu like symptoms) (seriousness criterion hospitalization), PARAESTHESIA (tingling in arms and feet) (seriousness criterion hospitalization), RASH (rashes in the body) (seriousness criterion hospitalization), PRURITUS (itchy) (seriousness criterion hospitalization) and ASTHENIA (weakness to the point that she could not walk) (seriousness criterion hospitalization). 21-Apr-2021, the patient experienced PAIN IN EXTREMITY (hurting arm). On 27-May-2021, the patient experienced CARDIAC FAILURE (heart failure) (seriousness criteria hospitalization and medically significant), RENAL FAILURE (kidney failure) (seriousness criteria hospitalization and medically significant), CARDIAC ARREST (Cardiac arrest) (seriousness criteria hospitalization prolonged and medically significant) and LUNG DISORDER (pulmonary issues) (seriousness criterion hospitalization). On 05-Jun-2021, the patient experienced CHEST PAIN (chest hurt) (seriousness criterion hospitalization). On 14-Jun-2021, the patient experienced CARDIAC ARREST (cardiac arrest) (seriousness criteria death and medically significant). On 27-May-2021, CARDIAC ARREST (Cardiac arrest) had resolved. The patient died on 14-Jun-2021. The reported cause of death was Cardiac arrest. It is unknown if an autopsy was performed. At the time of death, CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) outcome was unknown and PAIN IN EXTREMITY (hurting arm) had resolved.            No relevant medical history was reported. No concomitant medication provided. The patient was having respiratory problem few days  after the 2nd dose along with other issues. She was administered with asthma medicines. The name was not specified. Action taken with mRNA-1273 in response to the events was not Applicable.  Very limited information regarding this events has been provided at this time.  Further information has been requested.; Sender's Comments: Very limited information regarding this events has been provided at this time.  Further information has been requested.; Reported Cause(s) of Death: cardiac arrest"
	"1449786-1"	"1449786-1"	"PRURITUS"	"10037087"	"65-79 years"	"65-79"	"chest hurt; pulmonary issues; heart failure; kidney failure; Cardiac arrest; flu like symptoms; tingling in arms and feet; rashes in the body; itchy; weakness to the point that she could not walk; passed away; cardiac arrest; hurting arm; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away), CARDIAC ARREST (cardiac arrest), CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), CARDIAC ARREST (Cardiac arrest), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039B21A and 038A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.   On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 21-Apr-2021, the patient experienced INFLUENZA LIKE ILLNESS (flu like symptoms) (seriousness criterion hospitalization), PARAESTHESIA (tingling in arms and feet) (seriousness criterion hospitalization), RASH (rashes in the body) (seriousness criterion hospitalization), PRURITUS (itchy) (seriousness criterion hospitalization) and ASTHENIA (weakness to the point that she could not walk) (seriousness criterion hospitalization). 21-Apr-2021, the patient experienced PAIN IN EXTREMITY (hurting arm). On 27-May-2021, the patient experienced CARDIAC FAILURE (heart failure) (seriousness criteria hospitalization and medically significant), RENAL FAILURE (kidney failure) (seriousness criteria hospitalization and medically significant), CARDIAC ARREST (Cardiac arrest) (seriousness criteria hospitalization prolonged and medically significant) and LUNG DISORDER (pulmonary issues) (seriousness criterion hospitalization). On 05-Jun-2021, the patient experienced CHEST PAIN (chest hurt) (seriousness criterion hospitalization). On 14-Jun-2021, the patient experienced CARDIAC ARREST (cardiac arrest) (seriousness criteria death and medically significant). On 27-May-2021, CARDIAC ARREST (Cardiac arrest) had resolved. The patient died on 14-Jun-2021. The reported cause of death was Cardiac arrest. It is unknown if an autopsy was performed. At the time of death, CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) outcome was unknown and PAIN IN EXTREMITY (hurting arm) had resolved.            No relevant medical history was reported. No concomitant medication provided. The patient was having respiratory problem few days  after the 2nd dose along with other issues. She was administered with asthma medicines. The name was not specified. Action taken with mRNA-1273 in response to the events was not Applicable.  Very limited information regarding this events has been provided at this time.  Further information has been requested.; Sender's Comments: Very limited information regarding this events has been provided at this time.  Further information has been requested.; Reported Cause(s) of Death: cardiac arrest"
	"1449786-1"	"1449786-1"	"RASH"	"10037844"	"65-79 years"	"65-79"	"chest hurt; pulmonary issues; heart failure; kidney failure; Cardiac arrest; flu like symptoms; tingling in arms and feet; rashes in the body; itchy; weakness to the point that she could not walk; passed away; cardiac arrest; hurting arm; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away), CARDIAC ARREST (cardiac arrest), CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), CARDIAC ARREST (Cardiac arrest), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039B21A and 038A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.   On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 21-Apr-2021, the patient experienced INFLUENZA LIKE ILLNESS (flu like symptoms) (seriousness criterion hospitalization), PARAESTHESIA (tingling in arms and feet) (seriousness criterion hospitalization), RASH (rashes in the body) (seriousness criterion hospitalization), PRURITUS (itchy) (seriousness criterion hospitalization) and ASTHENIA (weakness to the point that she could not walk) (seriousness criterion hospitalization). 21-Apr-2021, the patient experienced PAIN IN EXTREMITY (hurting arm). On 27-May-2021, the patient experienced CARDIAC FAILURE (heart failure) (seriousness criteria hospitalization and medically significant), RENAL FAILURE (kidney failure) (seriousness criteria hospitalization and medically significant), CARDIAC ARREST (Cardiac arrest) (seriousness criteria hospitalization prolonged and medically significant) and LUNG DISORDER (pulmonary issues) (seriousness criterion hospitalization). On 05-Jun-2021, the patient experienced CHEST PAIN (chest hurt) (seriousness criterion hospitalization). On 14-Jun-2021, the patient experienced CARDIAC ARREST (cardiac arrest) (seriousness criteria death and medically significant). On 27-May-2021, CARDIAC ARREST (Cardiac arrest) had resolved. The patient died on 14-Jun-2021. The reported cause of death was Cardiac arrest. It is unknown if an autopsy was performed. At the time of death, CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) outcome was unknown and PAIN IN EXTREMITY (hurting arm) had resolved.            No relevant medical history was reported. No concomitant medication provided. The patient was having respiratory problem few days  after the 2nd dose along with other issues. She was administered with asthma medicines. The name was not specified. Action taken with mRNA-1273 in response to the events was not Applicable.  Very limited information regarding this events has been provided at this time.  Further information has been requested.; Sender's Comments: Very limited information regarding this events has been provided at this time.  Further information has been requested.; Reported Cause(s) of Death: cardiac arrest"
	"1449786-1"	"1449786-1"	"RENAL FAILURE"	"10038435"	"65-79 years"	"65-79"	"chest hurt; pulmonary issues; heart failure; kidney failure; Cardiac arrest; flu like symptoms; tingling in arms and feet; rashes in the body; itchy; weakness to the point that she could not walk; passed away; cardiac arrest; hurting arm; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away), CARDIAC ARREST (cardiac arrest), CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), CARDIAC ARREST (Cardiac arrest), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039B21A and 038A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.   On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 21-Apr-2021, the patient experienced INFLUENZA LIKE ILLNESS (flu like symptoms) (seriousness criterion hospitalization), PARAESTHESIA (tingling in arms and feet) (seriousness criterion hospitalization), RASH (rashes in the body) (seriousness criterion hospitalization), PRURITUS (itchy) (seriousness criterion hospitalization) and ASTHENIA (weakness to the point that she could not walk) (seriousness criterion hospitalization). 21-Apr-2021, the patient experienced PAIN IN EXTREMITY (hurting arm). On 27-May-2021, the patient experienced CARDIAC FAILURE (heart failure) (seriousness criteria hospitalization and medically significant), RENAL FAILURE (kidney failure) (seriousness criteria hospitalization and medically significant), CARDIAC ARREST (Cardiac arrest) (seriousness criteria hospitalization prolonged and medically significant) and LUNG DISORDER (pulmonary issues) (seriousness criterion hospitalization). On 05-Jun-2021, the patient experienced CHEST PAIN (chest hurt) (seriousness criterion hospitalization). On 14-Jun-2021, the patient experienced CARDIAC ARREST (cardiac arrest) (seriousness criteria death and medically significant). On 27-May-2021, CARDIAC ARREST (Cardiac arrest) had resolved. The patient died on 14-Jun-2021. The reported cause of death was Cardiac arrest. It is unknown if an autopsy was performed. At the time of death, CARDIAC FAILURE (heart failure), RENAL FAILURE (kidney failure), INFLUENZA LIKE ILLNESS (flu like symptoms), PARAESTHESIA (tingling in arms and feet), RASH (rashes in the body), PRURITUS (itchy), ASTHENIA (weakness to the point that she could not walk), LUNG DISORDER (pulmonary issues) and CHEST PAIN (chest hurt) outcome was unknown and PAIN IN EXTREMITY (hurting arm) had resolved.            No relevant medical history was reported. No concomitant medication provided. The patient was having respiratory problem few days  after the 2nd dose along with other issues. She was administered with asthma medicines. The name was not specified. Action taken with mRNA-1273 in response to the events was not Applicable.  Very limited information regarding this events has been provided at this time.  Further information has been requested.; Sender's Comments: Very limited information regarding this events has been provided at this time.  Further information has been requested.; Reported Cause(s) of Death: cardiac arrest"
	"1454552-1"	"1454552-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Patient vaccinated with pfizer COVID vaccines 02/26/21 and 03/18/21 Patient presented to ER due to nonhealing lesion of right heel as well as erythema and was admitted on 06/15/21 Patient tested negative for COVID-19 on 06/15/21 Patient deteriorated and tested again for COVID-19 and positive on 06/28/21 Patient expired on 07/01/21"
	"1454552-1"	"1454552-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient vaccinated with pfizer COVID vaccines 02/26/21 and 03/18/21 Patient presented to ER due to nonhealing lesion of right heel as well as erythema and was admitted on 06/15/21 Patient tested negative for COVID-19 on 06/15/21 Patient deteriorated and tested again for COVID-19 and positive on 06/28/21 Patient expired on 07/01/21"
	"1454552-1"	"1454552-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient vaccinated with pfizer COVID vaccines 02/26/21 and 03/18/21 Patient presented to ER due to nonhealing lesion of right heel as well as erythema and was admitted on 06/15/21 Patient tested negative for COVID-19 on 06/15/21 Patient deteriorated and tested again for COVID-19 and positive on 06/28/21 Patient expired on 07/01/21"
	"1454552-1"	"1454552-1"	"ERYTHEMA"	"10015150"	"65-79 years"	"65-79"	"Patient vaccinated with pfizer COVID vaccines 02/26/21 and 03/18/21 Patient presented to ER due to nonhealing lesion of right heel as well as erythema and was admitted on 06/15/21 Patient tested negative for COVID-19 on 06/15/21 Patient deteriorated and tested again for COVID-19 and positive on 06/28/21 Patient expired on 07/01/21"
	"1454552-1"	"1454552-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Patient vaccinated with pfizer COVID vaccines 02/26/21 and 03/18/21 Patient presented to ER due to nonhealing lesion of right heel as well as erythema and was admitted on 06/15/21 Patient tested negative for COVID-19 on 06/15/21 Patient deteriorated and tested again for COVID-19 and positive on 06/28/21 Patient expired on 07/01/21"
	"1454552-1"	"1454552-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient vaccinated with pfizer COVID vaccines 02/26/21 and 03/18/21 Patient presented to ER due to nonhealing lesion of right heel as well as erythema and was admitted on 06/15/21 Patient tested negative for COVID-19 on 06/15/21 Patient deteriorated and tested again for COVID-19 and positive on 06/28/21 Patient expired on 07/01/21"
	"1454552-1"	"1454552-1"	"SKIN ULCER"	"10040943"	"65-79 years"	"65-79"	"Patient vaccinated with pfizer COVID vaccines 02/26/21 and 03/18/21 Patient presented to ER due to nonhealing lesion of right heel as well as erythema and was admitted on 06/15/21 Patient tested negative for COVID-19 on 06/15/21 Patient deteriorated and tested again for COVID-19 and positive on 06/28/21 Patient expired on 07/01/21"
	"1454790-1"	"1454790-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient tested positive for COVID-19 on 03/29/2021 via both antigen and PCR despite being fully vaccinated. She was subsequently hospitalized and then died on 03/30/2021. Symptom onset for COVID-19 was 03/23/2021, with symptoms of fever (101.8) and respiratory distress which required an increase in oxygen.   Per the death certificate, causes of death are as follows:  Part 1: Cause of Death: A. Multi organ failure B. COVID-19 infection  Part 2: Other Significant Conditions:  Congestive Heart Failure, Diastolic Heart Failure with Preserved Ejection, history of cerebrovascular accident, diabetes mellitus type 2, and morbid obesity"
	"1454790-1"	"1454790-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient tested positive for COVID-19 on 03/29/2021 via both antigen and PCR despite being fully vaccinated. She was subsequently hospitalized and then died on 03/30/2021. Symptom onset for COVID-19 was 03/23/2021, with symptoms of fever (101.8) and respiratory distress which required an increase in oxygen.   Per the death certificate, causes of death are as follows:  Part 1: Cause of Death: A. Multi organ failure B. COVID-19 infection  Part 2: Other Significant Conditions:  Congestive Heart Failure, Diastolic Heart Failure with Preserved Ejection, history of cerebrovascular accident, diabetes mellitus type 2, and morbid obesity"
	"1454790-1"	"1454790-1"	"MULTIPLE ORGAN DYSFUNCTION SYNDROME"	"10077361"	"65-79 years"	"65-79"	"Patient tested positive for COVID-19 on 03/29/2021 via both antigen and PCR despite being fully vaccinated. She was subsequently hospitalized and then died on 03/30/2021. Symptom onset for COVID-19 was 03/23/2021, with symptoms of fever (101.8) and respiratory distress which required an increase in oxygen.   Per the death certificate, causes of death are as follows:  Part 1: Cause of Death: A. Multi organ failure B. COVID-19 infection  Part 2: Other Significant Conditions:  Congestive Heart Failure, Diastolic Heart Failure with Preserved Ejection, history of cerebrovascular accident, diabetes mellitus type 2, and morbid obesity"
	"1454790-1"	"1454790-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"Patient tested positive for COVID-19 on 03/29/2021 via both antigen and PCR despite being fully vaccinated. She was subsequently hospitalized and then died on 03/30/2021. Symptom onset for COVID-19 was 03/23/2021, with symptoms of fever (101.8) and respiratory distress which required an increase in oxygen.   Per the death certificate, causes of death are as follows:  Part 1: Cause of Death: A. Multi organ failure B. COVID-19 infection  Part 2: Other Significant Conditions:  Congestive Heart Failure, Diastolic Heart Failure with Preserved Ejection, history of cerebrovascular accident, diabetes mellitus type 2, and morbid obesity"
	"1454790-1"	"1454790-1"	"RESPIRATORY DISTRESS"	"10038687"	"65-79 years"	"65-79"	"Patient tested positive for COVID-19 on 03/29/2021 via both antigen and PCR despite being fully vaccinated. She was subsequently hospitalized and then died on 03/30/2021. Symptom onset for COVID-19 was 03/23/2021, with symptoms of fever (101.8) and respiratory distress which required an increase in oxygen.   Per the death certificate, causes of death are as follows:  Part 1: Cause of Death: A. Multi organ failure B. COVID-19 infection  Part 2: Other Significant Conditions:  Congestive Heart Failure, Diastolic Heart Failure with Preserved Ejection, history of cerebrovascular accident, diabetes mellitus type 2, and morbid obesity"
	"1454790-1"	"1454790-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient tested positive for COVID-19 on 03/29/2021 via both antigen and PCR despite being fully vaccinated. She was subsequently hospitalized and then died on 03/30/2021. Symptom onset for COVID-19 was 03/23/2021, with symptoms of fever (101.8) and respiratory distress which required an increase in oxygen.   Per the death certificate, causes of death are as follows:  Part 1: Cause of Death: A. Multi organ failure B. COVID-19 infection  Part 2: Other Significant Conditions:  Congestive Heart Failure, Diastolic Heart Failure with Preserved Ejection, history of cerebrovascular accident, diabetes mellitus type 2, and morbid obesity"
	"1454878-1"	"1454878-1"	"ANGIOGRAM PULMONARY ABNORMAL"	"10002441"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1454878-1"	"1454878-1"	"ATRIAL FIBRILLATION"	"10003658"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1454878-1"	"1454878-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1454878-1"	"1454878-1"	"CONTINUOUS POSITIVE AIRWAY PRESSURE"	"10052934"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1454878-1"	"1454878-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1454878-1"	"1454878-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1454878-1"	"1454878-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1454878-1"	"1454878-1"	"DIALYSIS"	"10061105"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1454878-1"	"1454878-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1454878-1"	"1454878-1"	"FRACTION OF INSPIRED OXYGEN"	"10059883"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1454878-1"	"1454878-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1454878-1"	"1454878-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1454878-1"	"1454878-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1454878-1"	"1454878-1"	"LUNG OPACITY"	"10081792"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1454878-1"	"1454878-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1454878-1"	"1454878-1"	"RESPIRATORY FAILURE"	"10038695"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1454878-1"	"1454878-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem.  Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone.  In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house.  On the afternoon of June 23 palliative team did meet with patient's siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation.  Patient died of COVID-19 despite being fully vaccinated against it.   Death Certificate Information:  Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease"
	"1481541-1"	"1481541-1"	"AUTOPSY"	"10050117"	"65-79 years"	"65-79"	"Sudden cardiac arrest 5/30/21 (4 days after vaccination)"
	"1481541-1"	"1481541-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Sudden cardiac arrest 5/30/21 (4 days after vaccination)"
	"1481541-1"	"1481541-1"	"MYOCARDITIS"	"10028606"	"65-79 years"	"65-79"	"Sudden cardiac arrest 5/30/21 (4 days after vaccination)"
	"1481541-1"	"1481541-1"	"SUDDEN CARDIAC DEATH"	"10049418"	"65-79 years"	"65-79"	"Sudden cardiac arrest 5/30/21 (4 days after vaccination)"
	"1483546-1"	"1483546-1"	"AORTIC ANEURYSM RUPTURE"	"10002886"	"65-79 years"	"65-79"	""Passed away/Hemorrhagic shock acute blood loss ruptured abdominal aortic aneurysm; Passed away/Hemorrhagic shock acute blood loss ruptured abdominal aortic aneurysm; Shingles; This is a spontaneous report received from a contactable consumer or other non hcp (patient's child). A 67-years-old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/lot number: ER8731) via an unspecified route of administration in arm (arm shoulder) on 18Apr2021 (age at vaccination 67years old) as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient had the test (before vaccination) where they put dye in the bloodstream and where they check for any ""insularism"" (presented as reported until clarified) or anything he had that process done, may be in March (result: not reported). There was no other prior vaccination. On 20Apr2021, the patient had shingles. He broke out to shingles 2 days after receiving the Pfizer Covid-19 vaccine, reported the shingles broke out. The patient went to the Doctor and they gave him some medicine (unspecified medication) for his pain (onset date: 2021). Therapeutic measures were taken as a result of shingles. In May2021 (one month to the date he got his vaccine exactly), the patient went into the hospital (as per death record but the patient told reporter that 2 days after getting the vaccine, he broke out shingles and when he called, they gave him a confirmation). The patient had hemorrhagic shock acute blood loss ruptured abdominal aortic aneurysm on an unspecified date and patient passed away (as per death record). The reporter stated that patient had passed away and reporter believed it was due to the Pfizer BioNTech Covid-19 Vaccine. The clinical outcome of the events shingles was unknown. The patient died on 20May2021. Autopsy was performed with results not reported.   Follow-Up 07Jul2021: Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: hemorrhagic shock acute blood loss; Acute blood loss ruptured abdominal aortic aneurysm""
	"1483546-1"	"1483546-1"	"HERPES ZOSTER"	"10019974"	"65-79 years"	"65-79"	""Passed away/Hemorrhagic shock acute blood loss ruptured abdominal aortic aneurysm; Passed away/Hemorrhagic shock acute blood loss ruptured abdominal aortic aneurysm; Shingles; This is a spontaneous report received from a contactable consumer or other non hcp (patient's child). A 67-years-old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/lot number: ER8731) via an unspecified route of administration in arm (arm shoulder) on 18Apr2021 (age at vaccination 67years old) as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient had the test (before vaccination) where they put dye in the bloodstream and where they check for any ""insularism"" (presented as reported until clarified) or anything he had that process done, may be in March (result: not reported). There was no other prior vaccination. On 20Apr2021, the patient had shingles. He broke out to shingles 2 days after receiving the Pfizer Covid-19 vaccine, reported the shingles broke out. The patient went to the Doctor and they gave him some medicine (unspecified medication) for his pain (onset date: 2021). Therapeutic measures were taken as a result of shingles. In May2021 (one month to the date he got his vaccine exactly), the patient went into the hospital (as per death record but the patient told reporter that 2 days after getting the vaccine, he broke out shingles and when he called, they gave him a confirmation). The patient had hemorrhagic shock acute blood loss ruptured abdominal aortic aneurysm on an unspecified date and patient passed away (as per death record). The reporter stated that patient had passed away and reporter believed it was due to the Pfizer BioNTech Covid-19 Vaccine. The clinical outcome of the events shingles was unknown. The patient died on 20May2021. Autopsy was performed with results not reported.   Follow-Up 07Jul2021: Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: hemorrhagic shock acute blood loss; Acute blood loss ruptured abdominal aortic aneurysm""
	"1483546-1"	"1483546-1"	"INVESTIGATION"	"10062026"	"65-79 years"	"65-79"	""Passed away/Hemorrhagic shock acute blood loss ruptured abdominal aortic aneurysm; Passed away/Hemorrhagic shock acute blood loss ruptured abdominal aortic aneurysm; Shingles; This is a spontaneous report received from a contactable consumer or other non hcp (patient's child). A 67-years-old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/lot number: ER8731) via an unspecified route of administration in arm (arm shoulder) on 18Apr2021 (age at vaccination 67years old) as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient had the test (before vaccination) where they put dye in the bloodstream and where they check for any ""insularism"" (presented as reported until clarified) or anything he had that process done, may be in March (result: not reported). There was no other prior vaccination. On 20Apr2021, the patient had shingles. He broke out to shingles 2 days after receiving the Pfizer Covid-19 vaccine, reported the shingles broke out. The patient went to the Doctor and they gave him some medicine (unspecified medication) for his pain (onset date: 2021). Therapeutic measures were taken as a result of shingles. In May2021 (one month to the date he got his vaccine exactly), the patient went into the hospital (as per death record but the patient told reporter that 2 days after getting the vaccine, he broke out shingles and when he called, they gave him a confirmation). The patient had hemorrhagic shock acute blood loss ruptured abdominal aortic aneurysm on an unspecified date and patient passed away (as per death record). The reporter stated that patient had passed away and reporter believed it was due to the Pfizer BioNTech Covid-19 Vaccine. The clinical outcome of the events shingles was unknown. The patient died on 20May2021. Autopsy was performed with results not reported.   Follow-Up 07Jul2021: Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: hemorrhagic shock acute blood loss; Acute blood loss ruptured abdominal aortic aneurysm""
	"1483546-1"	"1483546-1"	"SHOCK HAEMORRHAGIC"	"10049771"	"65-79 years"	"65-79"	""Passed away/Hemorrhagic shock acute blood loss ruptured abdominal aortic aneurysm; Passed away/Hemorrhagic shock acute blood loss ruptured abdominal aortic aneurysm; Shingles; This is a spontaneous report received from a contactable consumer or other non hcp (patient's child). A 67-years-old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/lot number: ER8731) via an unspecified route of administration in arm (arm shoulder) on 18Apr2021 (age at vaccination 67years old) as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient had the test (before vaccination) where they put dye in the bloodstream and where they check for any ""insularism"" (presented as reported until clarified) or anything he had that process done, may be in March (result: not reported). There was no other prior vaccination. On 20Apr2021, the patient had shingles. He broke out to shingles 2 days after receiving the Pfizer Covid-19 vaccine, reported the shingles broke out. The patient went to the Doctor and they gave him some medicine (unspecified medication) for his pain (onset date: 2021). Therapeutic measures were taken as a result of shingles. In May2021 (one month to the date he got his vaccine exactly), the patient went into the hospital (as per death record but the patient told reporter that 2 days after getting the vaccine, he broke out shingles and when he called, they gave him a confirmation). The patient had hemorrhagic shock acute blood loss ruptured abdominal aortic aneurysm on an unspecified date and patient passed away (as per death record). The reporter stated that patient had passed away and reporter believed it was due to the Pfizer BioNTech Covid-19 Vaccine. The clinical outcome of the events shingles was unknown. The patient died on 20May2021. Autopsy was performed with results not reported.   Follow-Up 07Jul2021: Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: hemorrhagic shock acute blood loss; Acute blood loss ruptured abdominal aortic aneurysm""
	"1490662-1"	"1490662-1"	"ANAPHYLACTIC REACTION"	"10002198"	"65-79 years"	"65-79"	""Office of the Regulatory Authority reported to the Dept. of Health that this patient had a ""sudden collapse witnessed by a friend"" approximately one hour after receiving vaccine. Notified in March. At that time no VAERS reports found or noted by CDC. As of today, no VAERS received from CDC for this patient so submitting the limited information available. Final findings were released on 7/18/21 (decided on 7/16/21) were:  ""CAUSE A: Anaphylaxis CAUSE B: Status post COVID vaccination Should you have any questions about this case please contact Dr. Please note he is leaving state service at the end of this month.""""
	"1490662-1"	"1490662-1"	"SYNCOPE"	"10042772"	"65-79 years"	"65-79"	""Office of the Regulatory Authority reported to the Dept. of Health that this patient had a ""sudden collapse witnessed by a friend"" approximately one hour after receiving vaccine. Notified in March. At that time no VAERS reports found or noted by CDC. As of today, no VAERS received from CDC for this patient so submitting the limited information available. Final findings were released on 7/18/21 (decided on 7/16/21) were:  ""CAUSE A: Anaphylaxis CAUSE B: Status post COVID vaccination Should you have any questions about this case please contact Dr. Please note he is leaving state service at the end of this month.""""
	"1498209-1"	"1498209-1"	"AGITATION"	"10001497"	"65-79 years"	"65-79"	"Per family had progressive decline post vaccination with agitation.  Significantly worse than prior baseline.  He was hospitalized and transitioned to inpatient hospice.  Time/Date of death   7/22/21 at 23:03pm"
	"1498209-1"	"1498209-1"	"COMPUTERISED TOMOGRAM HEAD"	"10054003"	"65-79 years"	"65-79"	"Per family had progressive decline post vaccination with agitation.  Significantly worse than prior baseline.  He was hospitalized and transitioned to inpatient hospice.  Time/Date of death   7/22/21 at 23:03pm"
	"1498209-1"	"1498209-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Per family had progressive decline post vaccination with agitation.  Significantly worse than prior baseline.  He was hospitalized and transitioned to inpatient hospice.  Time/Date of death   7/22/21 at 23:03pm"
	"1498209-1"	"1498209-1"	"ELECTROENCEPHALOGRAM"	"10014407"	"65-79 years"	"65-79"	"Per family had progressive decline post vaccination with agitation.  Significantly worse than prior baseline.  He was hospitalized and transitioned to inpatient hospice.  Time/Date of death   7/22/21 at 23:03pm"
	"1498209-1"	"1498209-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Per family had progressive decline post vaccination with agitation.  Significantly worse than prior baseline.  He was hospitalized and transitioned to inpatient hospice.  Time/Date of death   7/22/21 at 23:03pm"
	"1498209-1"	"1498209-1"	"LABORATORY TEST"	"10059938"	"65-79 years"	"65-79"	"Per family had progressive decline post vaccination with agitation.  Significantly worse than prior baseline.  He was hospitalized and transitioned to inpatient hospice.  Time/Date of death   7/22/21 at 23:03pm"
	"1498209-1"	"1498209-1"	"LUMBAR PUNCTURE"	"10024999"	"65-79 years"	"65-79"	"Per family had progressive decline post vaccination with agitation.  Significantly worse than prior baseline.  He was hospitalized and transitioned to inpatient hospice.  Time/Date of death   7/22/21 at 23:03pm"
	"1499484-1"	"1499484-1"	"AUTOPSY"	"10050117"	"65-79 years"	"65-79"	"Completed 2nd COVID-19 vaccine March 16, 2021 - On May 13, 2021, he had massive pulmonary embolism resulting in cardiac arrest.  Pulmonary embolism occluded pulmonary arteries to both lungs."
	"1499484-1"	"1499484-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Completed 2nd COVID-19 vaccine March 16, 2021 - On May 13, 2021, he had massive pulmonary embolism resulting in cardiac arrest.  Pulmonary embolism occluded pulmonary arteries to both lungs."
	"1499484-1"	"1499484-1"	"PULMONARY ARTERY OCCLUSION"	"10078201"	"65-79 years"	"65-79"	"Completed 2nd COVID-19 vaccine March 16, 2021 - On May 13, 2021, he had massive pulmonary embolism resulting in cardiac arrest.  Pulmonary embolism occluded pulmonary arteries to both lungs."
	"1499484-1"	"1499484-1"	"PULMONARY EMBOLISM"	"10037377"	"65-79 years"	"65-79"	"Completed 2nd COVID-19 vaccine March 16, 2021 - On May 13, 2021, he had massive pulmonary embolism resulting in cardiac arrest.  Pulmonary embolism occluded pulmonary arteries to both lungs."
	"1501871-1"	"1501871-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"COVID-19 Breakthrough disease which possibly resulted in death. Patient was fully vaccinated and was COVID-19 positive at time of death. Patient had symptom of cough that began 7/17/2021; the patient died on 07/20/2021. Patient tested positive for COVID-19 on 7/20/2021 at the long-term care facility at which they were a resident. I do not have death certificate details available at this time."
	"1501871-1"	"1501871-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"COVID-19 Breakthrough disease which possibly resulted in death. Patient was fully vaccinated and was COVID-19 positive at time of death. Patient had symptom of cough that began 7/17/2021; the patient died on 07/20/2021. Patient tested positive for COVID-19 on 7/20/2021 at the long-term care facility at which they were a resident. I do not have death certificate details available at this time."
	"1501871-1"	"1501871-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"COVID-19 Breakthrough disease which possibly resulted in death. Patient was fully vaccinated and was COVID-19 positive at time of death. Patient had symptom of cough that began 7/17/2021; the patient died on 07/20/2021. Patient tested positive for COVID-19 on 7/20/2021 at the long-term care facility at which they were a resident. I do not have death certificate details available at this time."
	"1501871-1"	"1501871-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"COVID-19 Breakthrough disease which possibly resulted in death. Patient was fully vaccinated and was COVID-19 positive at time of death. Patient had symptom of cough that began 7/17/2021; the patient died on 07/20/2021. Patient tested positive for COVID-19 on 7/20/2021 at the long-term care facility at which they were a resident. I do not have death certificate details available at this time."
	"1522892-1"	"1522892-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"7/26/2021 TESTED FOR COVID AT CLINIC RESULTS = DETECTED. 7/28/2021 PATIENT ADMITTED TO HOSPITAL FOR COVID PNA 8/1/2021 PATIENT DIED."
	"1522892-1"	"1522892-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"7/26/2021 TESTED FOR COVID AT CLINIC RESULTS = DETECTED. 7/28/2021 PATIENT ADMITTED TO HOSPITAL FOR COVID PNA 8/1/2021 PATIENT DIED."
	"1522892-1"	"1522892-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"7/26/2021 TESTED FOR COVID AT CLINIC RESULTS = DETECTED. 7/28/2021 PATIENT ADMITTED TO HOSPITAL FOR COVID PNA 8/1/2021 PATIENT DIED."
	"1522892-1"	"1522892-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"7/26/2021 TESTED FOR COVID AT CLINIC RESULTS = DETECTED. 7/28/2021 PATIENT ADMITTED TO HOSPITAL FOR COVID PNA 8/1/2021 PATIENT DIED."
	"1523317-1"	"1523317-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Pt. passed while inpt. at Hospital on 7/28/21 from COVID19 disease."
	"1523317-1"	"1523317-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt. passed while inpt. at Hospital on 7/28/21 from COVID19 disease."
	"1525685-1"	"1525685-1"	"BLADDER CATHETERISATION"	"10005028"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"BLOOD PRESSURE ABNORMAL"	"10005728"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"BLOOD PRESSURE FLUCTUATION"	"10005746"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"BLOOD TEST"	"10061726"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"BODY TEMPERATURE DECREASED"	"10005910"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"CHEST X-RAY"	"10008498"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"FOAMING AT MOUTH"	"10062654"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"HYPOTHERMIA"	"10021113"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"IRRITABILITY"	"10022998"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"LETHARGY"	"10024264"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"LOSS OF CONSCIOUSNESS"	"10024855"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"MAGNETIC RESONANCE IMAGING"	"10078223"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"PERIPHERAL COLDNESS"	"10034568"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"PNEUMONIA"	"10035664"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"RENAL FAILURE"	"10038435"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"RENAL INJURY"	"10061481"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"SEPSIS"	"10040047"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"ULTRASOUND SCAN"	"10045434"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525685-1"	"1525685-1"	"URINARY RETENTION"	"10046555"	"65-79 years"	"65-79"	"Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to  get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him  to hospice. He was Hypothermic, kidney failure and sepsis."
	"1525971-1"	"1525971-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received vaccine on 2/12/2021 and 3/12/2021. He was admitted to the hospital on 6/23/2021 and passed away on 6/29/2021."
	"1525985-1"	"1525985-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received vaccines on 2/12/2021 and 3/12/2021. He was admitted to the hospital on 7/4/2021 and passed away 7/20/2021."
	"1528841-1"	"1528841-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"COVID-19 BREAKTHROUGH CASE THAT EXPIRED APPROXIMATELY THREE MONTHS AFTER COMPLETING VACCINATION SERIES."
	"1528841-1"	"1528841-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"COVID-19 BREAKTHROUGH CASE THAT EXPIRED APPROXIMATELY THREE MONTHS AFTER COMPLETING VACCINATION SERIES."
	"1528841-1"	"1528841-1"	"INFECTION"	"10021789"	"65-79 years"	"65-79"	"COVID-19 BREAKTHROUGH CASE THAT EXPIRED APPROXIMATELY THREE MONTHS AFTER COMPLETING VACCINATION SERIES."
	"1528852-1"	"1528852-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"COVID -19 BREAKTHROUGH CASE THAT EXPIRED FOUR MONTHS AFTER COMPLETING COVID VACCINATION SERIES."
	"1528852-1"	"1528852-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"COVID -19 BREAKTHROUGH CASE THAT EXPIRED FOUR MONTHS AFTER COMPLETING COVID VACCINATION SERIES."
	"1528852-1"	"1528852-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"COVID -19 BREAKTHROUGH CASE THAT EXPIRED FOUR MONTHS AFTER COMPLETING COVID VACCINATION SERIES."
	"1529110-1"	"1529110-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death on 8/2/2021"
	"1531963-1"	"1531963-1"	"ANAEMIA"	"10002034"	"65-79 years"	"65-79"	"Began on February 11, 2021:  thrombocytopenia, anemia, pneumonia, multiple pulmonary embolisms, pulmonary aspergillosis pneumonia"
	"1531963-1"	"1531963-1"	"BIOPSY BONE MARROW"	"10004737"	"65-79 years"	"65-79"	"Began on February 11, 2021:  thrombocytopenia, anemia, pneumonia, multiple pulmonary embolisms, pulmonary aspergillosis pneumonia"
	"1531963-1"	"1531963-1"	"BIOPSY LUNG"	"10004794"	"65-79 years"	"65-79"	"Began on February 11, 2021:  thrombocytopenia, anemia, pneumonia, multiple pulmonary embolisms, pulmonary aspergillosis pneumonia"
	"1531963-1"	"1531963-1"	"BLOOD TEST"	"10061726"	"65-79 years"	"65-79"	"Began on February 11, 2021:  thrombocytopenia, anemia, pneumonia, multiple pulmonary embolisms, pulmonary aspergillosis pneumonia"
	"1531963-1"	"1531963-1"	"BRONCHOPULMONARY ASPERGILLOSIS"	"10006473"	"65-79 years"	"65-79"	"Began on February 11, 2021:  thrombocytopenia, anemia, pneumonia, multiple pulmonary embolisms, pulmonary aspergillosis pneumonia"
	"1531963-1"	"1531963-1"	"CHEST X-RAY"	"10008498"	"65-79 years"	"65-79"	"Began on February 11, 2021:  thrombocytopenia, anemia, pneumonia, multiple pulmonary embolisms, pulmonary aspergillosis pneumonia"
	"1531963-1"	"1531963-1"	"COMPUTERISED TOMOGRAM"	"10010234"	"65-79 years"	"65-79"	"Began on February 11, 2021:  thrombocytopenia, anemia, pneumonia, multiple pulmonary embolisms, pulmonary aspergillosis pneumonia"
	"1531963-1"	"1531963-1"	"PNEUMONIA"	"10035664"	"65-79 years"	"65-79"	"Began on February 11, 2021:  thrombocytopenia, anemia, pneumonia, multiple pulmonary embolisms, pulmonary aspergillosis pneumonia"
	"1531963-1"	"1531963-1"	"PULMONARY EMBOLISM"	"10037377"	"65-79 years"	"65-79"	"Began on February 11, 2021:  thrombocytopenia, anemia, pneumonia, multiple pulmonary embolisms, pulmonary aspergillosis pneumonia"
	"1531963-1"	"1531963-1"	"THROMBOCYTOPENIA"	"10043554"	"65-79 years"	"65-79"	"Began on February 11, 2021:  thrombocytopenia, anemia, pneumonia, multiple pulmonary embolisms, pulmonary aspergillosis pneumonia"
	"1532064-1"	"1532064-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Case had COVID vaccines x 2. Last vaccine given at HCF on 2/12/21. Case presented to ED on 7/24/2021 with covid like symptoms. Postitive test for COVID 19 and was admitted to another HCF on 7/24/2021. He expired at that facility on 8/4/21."
	"1532064-1"	"1532064-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Case had COVID vaccines x 2. Last vaccine given at HCF on 2/12/21. Case presented to ED on 7/24/2021 with covid like symptoms. Postitive test for COVID 19 and was admitted to another HCF on 7/24/2021. He expired at that facility on 8/4/21."
	"1532064-1"	"1532064-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Case had COVID vaccines x 2. Last vaccine given at HCF on 2/12/21. Case presented to ED on 7/24/2021 with covid like symptoms. Postitive test for COVID 19 and was admitted to another HCF on 7/24/2021. He expired at that facility on 8/4/21."
	"1532064-1"	"1532064-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Case had COVID vaccines x 2. Last vaccine given at HCF on 2/12/21. Case presented to ED on 7/24/2021 with covid like symptoms. Postitive test for COVID 19 and was admitted to another HCF on 7/24/2021. He expired at that facility on 8/4/21."
	"1534654-1"	"1534654-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient started feeling bad the day following the injection.  Tired, diarrhea, nausea. Death - Died on 4/12/21 at approximately 5:00 AM"
	"1534654-1"	"1534654-1"	"DIARRHOEA"	"10012735"	"65-79 years"	"65-79"	"Patient started feeling bad the day following the injection.  Tired, diarrhea, nausea. Death - Died on 4/12/21 at approximately 5:00 AM"
	"1534654-1"	"1534654-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"Patient started feeling bad the day following the injection.  Tired, diarrhea, nausea. Death - Died on 4/12/21 at approximately 5:00 AM"
	"1534654-1"	"1534654-1"	"FEELING ABNORMAL"	"10016322"	"65-79 years"	"65-79"	"Patient started feeling bad the day following the injection.  Tired, diarrhea, nausea. Death - Died on 4/12/21 at approximately 5:00 AM"
	"1534654-1"	"1534654-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"Patient started feeling bad the day following the injection.  Tired, diarrhea, nausea. Death - Died on 4/12/21 at approximately 5:00 AM"
	"1536142-1"	"1536142-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"Admitted to hospital on 7/20/21 with respiratory congestion, dry cough and rhinorrhea after positive COVID test on 7/15.  Resulted in acute hypoxic respiratory failure with death 8/6/21."
	"1536142-1"	"1536142-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Admitted to hospital on 7/20/21 with respiratory congestion, dry cough and rhinorrhea after positive COVID test on 7/15.  Resulted in acute hypoxic respiratory failure with death 8/6/21."
	"1536142-1"	"1536142-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Admitted to hospital on 7/20/21 with respiratory congestion, dry cough and rhinorrhea after positive COVID test on 7/15.  Resulted in acute hypoxic respiratory failure with death 8/6/21."
	"1536142-1"	"1536142-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Admitted to hospital on 7/20/21 with respiratory congestion, dry cough and rhinorrhea after positive COVID test on 7/15.  Resulted in acute hypoxic respiratory failure with death 8/6/21."
	"1536142-1"	"1536142-1"	"RESPIRATORY TRACT CONGESTION"	"10052251"	"65-79 years"	"65-79"	"Admitted to hospital on 7/20/21 with respiratory congestion, dry cough and rhinorrhea after positive COVID test on 7/15.  Resulted in acute hypoxic respiratory failure with death 8/6/21."
	"1536142-1"	"1536142-1"	"RHINORRHOEA"	"10039101"	"65-79 years"	"65-79"	"Admitted to hospital on 7/20/21 with respiratory congestion, dry cough and rhinorrhea after positive COVID test on 7/15.  Resulted in acute hypoxic respiratory failure with death 8/6/21."
	"1536142-1"	"1536142-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Admitted to hospital on 7/20/21 with respiratory congestion, dry cough and rhinorrhea after positive COVID test on 7/15.  Resulted in acute hypoxic respiratory failure with death 8/6/21."
	"1536271-1"	"1536271-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Pt. passed from COVID19 Pneumonia on 8/6/2021"
	"1536271-1"	"1536271-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt. passed from COVID19 Pneumonia on 8/6/2021"
	"1536521-1"	"1536521-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Extremely sick & Died on 06/14/2021"
	"1536521-1"	"1536521-1"	"ILLNESS"	"10080284"	"65-79 years"	"65-79"	"Extremely sick & Died on 06/14/2021"
	"1545175-1"	"1545175-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"PT IS A COVID-19 BREAKTHROUGH CASE THAT EXPIRED ON 8/10/2021.   NEARLY 5 MONTHS AFTER COMPLETING SERIES. HEALTH DEPARTMENT WAS NOT THE VACCINATING FACILITY BUT WE ARE THE REPORTING FACILITY."
	"1545175-1"	"1545175-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"PT IS A COVID-19 BREAKTHROUGH CASE THAT EXPIRED ON 8/10/2021.   NEARLY 5 MONTHS AFTER COMPLETING SERIES. HEALTH DEPARTMENT WAS NOT THE VACCINATING FACILITY BUT WE ARE THE REPORTING FACILITY."
	"1545175-1"	"1545175-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"PT IS A COVID-19 BREAKTHROUGH CASE THAT EXPIRED ON 8/10/2021.   NEARLY 5 MONTHS AFTER COMPLETING SERIES. HEALTH DEPARTMENT WAS NOT THE VACCINATING FACILITY BUT WE ARE THE REPORTING FACILITY."
	"1545589-1"	"1545589-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"Pt admitted to hospital on 7/25/21 with shortness of breath, which turned out to be positive for Covid-19.  Pulmonology was consulted and patient was started on dexamethasone, remdesivir, baricitinib, as well as Tocilizumab.  Started on vapotherm O2 with Fi02 of 100 %.  Despite aggressive measures patient condition deteriorated.  Family made patient a do not resuscitate, and patient expired on 7/28/21."
	"1545589-1"	"1545589-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Pt admitted to hospital on 7/25/21 with shortness of breath, which turned out to be positive for Covid-19.  Pulmonology was consulted and patient was started on dexamethasone, remdesivir, baricitinib, as well as Tocilizumab.  Started on vapotherm O2 with Fi02 of 100 %.  Despite aggressive measures patient condition deteriorated.  Family made patient a do not resuscitate, and patient expired on 7/28/21."
	"1545589-1"	"1545589-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pt admitted to hospital on 7/25/21 with shortness of breath, which turned out to be positive for Covid-19.  Pulmonology was consulted and patient was started on dexamethasone, remdesivir, baricitinib, as well as Tocilizumab.  Started on vapotherm O2 with Fi02 of 100 %.  Despite aggressive measures patient condition deteriorated.  Family made patient a do not resuscitate, and patient expired on 7/28/21."
	"1545589-1"	"1545589-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Pt admitted to hospital on 7/25/21 with shortness of breath, which turned out to be positive for Covid-19.  Pulmonology was consulted and patient was started on dexamethasone, remdesivir, baricitinib, as well as Tocilizumab.  Started on vapotherm O2 with Fi02 of 100 %.  Despite aggressive measures patient condition deteriorated.  Family made patient a do not resuscitate, and patient expired on 7/28/21."
	"1545589-1"	"1545589-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Pt admitted to hospital on 7/25/21 with shortness of breath, which turned out to be positive for Covid-19.  Pulmonology was consulted and patient was started on dexamethasone, remdesivir, baricitinib, as well as Tocilizumab.  Started on vapotherm O2 with Fi02 of 100 %.  Despite aggressive measures patient condition deteriorated.  Family made patient a do not resuscitate, and patient expired on 7/28/21."
	"1545589-1"	"1545589-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Pt admitted to hospital on 7/25/21 with shortness of breath, which turned out to be positive for Covid-19.  Pulmonology was consulted and patient was started on dexamethasone, remdesivir, baricitinib, as well as Tocilizumab.  Started on vapotherm O2 with Fi02 of 100 %.  Despite aggressive measures patient condition deteriorated.  Family made patient a do not resuscitate, and patient expired on 7/28/21."
	"1545923-1"	"1545923-1"	"COMPUTERISED TOMOGRAM ABDOMEN"	"10053876"	"65-79 years"	"65-79"	"Patient presented 3 weeks after vaccination with massive bilateral femoral and portal visceral thrombosis. Taken to surgery and resected dead bowel. Thrombosis progressed and patient died after 2 days."
	"1545923-1"	"1545923-1"	"COMPUTERISED TOMOGRAM ABNORMAL"	"10010235"	"65-79 years"	"65-79"	"Patient presented 3 weeks after vaccination with massive bilateral femoral and portal visceral thrombosis. Taken to surgery and resected dead bowel. Thrombosis progressed and patient died after 2 days."
	"1545923-1"	"1545923-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient presented 3 weeks after vaccination with massive bilateral femoral and portal visceral thrombosis. Taken to surgery and resected dead bowel. Thrombosis progressed and patient died after 2 days."
	"1545923-1"	"1545923-1"	"DEEP VEIN THROMBOSIS"	"10051055"	"65-79 years"	"65-79"	"Patient presented 3 weeks after vaccination with massive bilateral femoral and portal visceral thrombosis. Taken to surgery and resected dead bowel. Thrombosis progressed and patient died after 2 days."
	"1545923-1"	"1545923-1"	"GASTROINTESTINAL NECROSIS"	"10017982"	"65-79 years"	"65-79"	"Patient presented 3 weeks after vaccination with massive bilateral femoral and portal visceral thrombosis. Taken to surgery and resected dead bowel. Thrombosis progressed and patient died after 2 days."
	"1545923-1"	"1545923-1"	"INTESTINAL RESECTION"	"10054193"	"65-79 years"	"65-79"	"Patient presented 3 weeks after vaccination with massive bilateral femoral and portal visceral thrombosis. Taken to surgery and resected dead bowel. Thrombosis progressed and patient died after 2 days."
	"1545923-1"	"1545923-1"	"PORTAL VEIN THROMBOSIS"	"10036206"	"65-79 years"	"65-79"	"Patient presented 3 weeks after vaccination with massive bilateral femoral and portal visceral thrombosis. Taken to surgery and resected dead bowel. Thrombosis progressed and patient died after 2 days."
	"1545923-1"	"1545923-1"	"SURGERY"	"10042609"	"65-79 years"	"65-79"	"Patient presented 3 weeks after vaccination with massive bilateral femoral and portal visceral thrombosis. Taken to surgery and resected dead bowel. Thrombosis progressed and patient died after 2 days."
	"1545923-1"	"1545923-1"	"VISCERAL VENOUS THROMBOSIS"	"10077829"	"65-79 years"	"65-79"	"Patient presented 3 weeks after vaccination with massive bilateral femoral and portal visceral thrombosis. Taken to surgery and resected dead bowel. Thrombosis progressed and patient died after 2 days."
	"1549143-1"	"1549143-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"PASSES AWAY ON 7/25/21 OF UNKNOWN CAUSE BUT HAD PERICARDITIS"
	"1549143-1"	"1549143-1"	"PERICARDITIS"	"10034484"	"65-79 years"	"65-79"	"PASSES AWAY ON 7/25/21 OF UNKNOWN CAUSE BUT HAD PERICARDITIS"
	"1554322-1"	"1554322-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	"Case was vaccinated with covid vaccine on 5/6/21 & 5/27/21. Was admitted to Medical Center on 8/2/2021 with chest pain and shortness of breath. Tested positive for COVID 19. Case expired at Medical Center on 8/10/21."
	"1554322-1"	"1554322-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Case was vaccinated with covid vaccine on 5/6/21 & 5/27/21. Was admitted to Medical Center on 8/2/2021 with chest pain and shortness of breath. Tested positive for COVID 19. Case expired at Medical Center on 8/10/21."
	"1554322-1"	"1554322-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Case was vaccinated with covid vaccine on 5/6/21 & 5/27/21. Was admitted to Medical Center on 8/2/2021 with chest pain and shortness of breath. Tested positive for COVID 19. Case expired at Medical Center on 8/10/21."
	"1554322-1"	"1554322-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Case was vaccinated with covid vaccine on 5/6/21 & 5/27/21. Was admitted to Medical Center on 8/2/2021 with chest pain and shortness of breath. Tested positive for COVID 19. Case expired at Medical Center on 8/10/21."
	"1554322-1"	"1554322-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Case was vaccinated with covid vaccine on 5/6/21 & 5/27/21. Was admitted to Medical Center on 8/2/2021 with chest pain and shortness of breath. Tested positive for COVID 19. Case expired at Medical Center on 8/10/21."
	"1583081-1"	"1583081-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"COVID19 death"
	"1583081-1"	"1583081-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"COVID19 death"
	"1587163-1"	"1587163-1"	"ASTHMA EXERCISE INDUCED"	"10003557"	"65-79 years"	"65-79"	""About 2 wks post vaccine my husband started to develop dyspnea which appeared at that time on exertion (walking & exercise). Probably took another week to get into the doctor but I do not remember for sure.  Dr. Diagnosed him with exertional asthma. He was put on inhalers and a medication.  I do not know what medication.  He seemed to be getting worse and was put on a more potent inhaler with cortisone and took an OTC supplement called NAC which he bought at a healthfood store.  Then on May 19 at 7;45am we were sitting on the sofa having morning  coffee.  I noticed he was  having what looked like a  worse breathing episode. I asked if I should call 911.  He said, ""No, this will pass."" So I said I was going to take a Pulse/Oximeter reading because I brought that and an AED from our surgery center which we had just closed and retired in 2019.  His O2 was 100% w 62 pulse.  That looked good to me. I layed down the Pulse/Oximeter and  about a minute or two he had a cardia arrest! I called 911, pulled him on the floor and started CPR while talking with the EMS all the while. I stopped for a minute to put on the AED.  I told EMS I am going to defibrillate , he has not pulse!  The AED did not go off.  I continued CPR, then the EMS came and started CPR and tried defibrillation but theirs did not go off. The EMS told me he was in a PEA (pulseless electrical activity) where he had not heartbeat but still had electrical activity in his body so the the debribrillators  read it as a rythymn that was not amenable to defibrillation..   Now I found out the threat of blod clots and feel that is what he had!""
	"1587163-1"	"1587163-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	""About 2 wks post vaccine my husband started to develop dyspnea which appeared at that time on exertion (walking & exercise). Probably took another week to get into the doctor but I do not remember for sure.  Dr. Diagnosed him with exertional asthma. He was put on inhalers and a medication.  I do not know what medication.  He seemed to be getting worse and was put on a more potent inhaler with cortisone and took an OTC supplement called NAC which he bought at a healthfood store.  Then on May 19 at 7;45am we were sitting on the sofa having morning  coffee.  I noticed he was  having what looked like a  worse breathing episode. I asked if I should call 911.  He said, ""No, this will pass."" So I said I was going to take a Pulse/Oximeter reading because I brought that and an AED from our surgery center which we had just closed and retired in 2019.  His O2 was 100% w 62 pulse.  That looked good to me. I layed down the Pulse/Oximeter and  about a minute or two he had a cardia arrest! I called 911, pulled him on the floor and started CPR while talking with the EMS all the while. I stopped for a minute to put on the AED.  I told EMS I am going to defibrillate , he has not pulse!  The AED did not go off.  I continued CPR, then the EMS came and started CPR and tried defibrillation but theirs did not go off. The EMS told me he was in a PEA (pulseless electrical activity) where he had not heartbeat but still had electrical activity in his body so the the debribrillators  read it as a rythymn that was not amenable to defibrillation..   Now I found out the threat of blod clots and feel that is what he had!""
	"1587163-1"	"1587163-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	""About 2 wks post vaccine my husband started to develop dyspnea which appeared at that time on exertion (walking & exercise). Probably took another week to get into the doctor but I do not remember for sure.  Dr. Diagnosed him with exertional asthma. He was put on inhalers and a medication.  I do not know what medication.  He seemed to be getting worse and was put on a more potent inhaler with cortisone and took an OTC supplement called NAC which he bought at a healthfood store.  Then on May 19 at 7;45am we were sitting on the sofa having morning  coffee.  I noticed he was  having what looked like a  worse breathing episode. I asked if I should call 911.  He said, ""No, this will pass."" So I said I was going to take a Pulse/Oximeter reading because I brought that and an AED from our surgery center which we had just closed and retired in 2019.  His O2 was 100% w 62 pulse.  That looked good to me. I layed down the Pulse/Oximeter and  about a minute or two he had a cardia arrest! I called 911, pulled him on the floor and started CPR while talking with the EMS all the while. I stopped for a minute to put on the AED.  I told EMS I am going to defibrillate , he has not pulse!  The AED did not go off.  I continued CPR, then the EMS came and started CPR and tried defibrillation but theirs did not go off. The EMS told me he was in a PEA (pulseless electrical activity) where he had not heartbeat but still had electrical activity in his body so the the debribrillators  read it as a rythymn that was not amenable to defibrillation..   Now I found out the threat of blod clots and feel that is what he had!""
	"1587163-1"	"1587163-1"	"DYSPNOEA EXERTIONAL"	"10013971"	"65-79 years"	"65-79"	""About 2 wks post vaccine my husband started to develop dyspnea which appeared at that time on exertion (walking & exercise). Probably took another week to get into the doctor but I do not remember for sure.  Dr. Diagnosed him with exertional asthma. He was put on inhalers and a medication.  I do not know what medication.  He seemed to be getting worse and was put on a more potent inhaler with cortisone and took an OTC supplement called NAC which he bought at a healthfood store.  Then on May 19 at 7;45am we were sitting on the sofa having morning  coffee.  I noticed he was  having what looked like a  worse breathing episode. I asked if I should call 911.  He said, ""No, this will pass."" So I said I was going to take a Pulse/Oximeter reading because I brought that and an AED from our surgery center which we had just closed and retired in 2019.  His O2 was 100% w 62 pulse.  That looked good to me. I layed down the Pulse/Oximeter and  about a minute or two he had a cardia arrest! I called 911, pulled him on the floor and started CPR while talking with the EMS all the while. I stopped for a minute to put on the AED.  I told EMS I am going to defibrillate , he has not pulse!  The AED did not go off.  I continued CPR, then the EMS came and started CPR and tried defibrillation but theirs did not go off. The EMS told me he was in a PEA (pulseless electrical activity) where he had not heartbeat but still had electrical activity in his body so the the debribrillators  read it as a rythymn that was not amenable to defibrillation..   Now I found out the threat of blod clots and feel that is what he had!""
	"1587163-1"	"1587163-1"	"PULSELESS ELECTRICAL ACTIVITY"	"10058151"	"65-79 years"	"65-79"	""About 2 wks post vaccine my husband started to develop dyspnea which appeared at that time on exertion (walking & exercise). Probably took another week to get into the doctor but I do not remember for sure.  Dr. Diagnosed him with exertional asthma. He was put on inhalers and a medication.  I do not know what medication.  He seemed to be getting worse and was put on a more potent inhaler with cortisone and took an OTC supplement called NAC which he bought at a healthfood store.  Then on May 19 at 7;45am we were sitting on the sofa having morning  coffee.  I noticed he was  having what looked like a  worse breathing episode. I asked if I should call 911.  He said, ""No, this will pass."" So I said I was going to take a Pulse/Oximeter reading because I brought that and an AED from our surgery center which we had just closed and retired in 2019.  His O2 was 100% w 62 pulse.  That looked good to me. I layed down the Pulse/Oximeter and  about a minute or two he had a cardia arrest! I called 911, pulled him on the floor and started CPR while talking with the EMS all the while. I stopped for a minute to put on the AED.  I told EMS I am going to defibrillate , he has not pulse!  The AED did not go off.  I continued CPR, then the EMS came and started CPR and tried defibrillation but theirs did not go off. The EMS told me he was in a PEA (pulseless electrical activity) where he had not heartbeat but still had electrical activity in his body so the the debribrillators  read it as a rythymn that was not amenable to defibrillation..   Now I found out the threat of blod clots and feel that is what he had!""
	"1587163-1"	"1587163-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	""About 2 wks post vaccine my husband started to develop dyspnea which appeared at that time on exertion (walking & exercise). Probably took another week to get into the doctor but I do not remember for sure.  Dr. Diagnosed him with exertional asthma. He was put on inhalers and a medication.  I do not know what medication.  He seemed to be getting worse and was put on a more potent inhaler with cortisone and took an OTC supplement called NAC which he bought at a healthfood store.  Then on May 19 at 7;45am we were sitting on the sofa having morning  coffee.  I noticed he was  having what looked like a  worse breathing episode. I asked if I should call 911.  He said, ""No, this will pass."" So I said I was going to take a Pulse/Oximeter reading because I brought that and an AED from our surgery center which we had just closed and retired in 2019.  His O2 was 100% w 62 pulse.  That looked good to me. I layed down the Pulse/Oximeter and  about a minute or two he had a cardia arrest! I called 911, pulled him on the floor and started CPR while talking with the EMS all the while. I stopped for a minute to put on the AED.  I told EMS I am going to defibrillate , he has not pulse!  The AED did not go off.  I continued CPR, then the EMS came and started CPR and tried defibrillation but theirs did not go off. The EMS told me he was in a PEA (pulseless electrical activity) where he had not heartbeat but still had electrical activity in his body so the the debribrillators  read it as a rythymn that was not amenable to defibrillation..   Now I found out the threat of blod clots and feel that is what he had!""
	"1591428-1"	"1591428-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"POSITIVE COVID TEST"
	"1591428-1"	"1591428-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"POSITIVE COVID TEST"
	"1591660-1"	"1591660-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient received covid vaccine x 2. Last dose on 1/27/21. Admitted to Hospital on 8/9/2021 with covid symptom and tested positive for COVID 19 upon admission. Case expired at hospital on 8/17/2021."
	"1591660-1"	"1591660-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received covid vaccine x 2. Last dose on 1/27/21. Admitted to Hospital on 8/9/2021 with covid symptom and tested positive for COVID 19 upon admission. Case expired at hospital on 8/17/2021."
	"1591660-1"	"1591660-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"Patient received covid vaccine x 2. Last dose on 1/27/21. Admitted to Hospital on 8/9/2021 with covid symptom and tested positive for COVID 19 upon admission. Case expired at hospital on 8/17/2021."
	"1591660-1"	"1591660-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient received covid vaccine x 2. Last dose on 1/27/21. Admitted to Hospital on 8/9/2021 with covid symptom and tested positive for COVID 19 upon admission. Case expired at hospital on 8/17/2021."
	"1628076-1"	"1628076-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Vaccinated hospitalized patient expired 8/14/2021"
	"1628365-1"	"1628365-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Vaccinated patient deceased from COVID."
	"1628365-1"	"1628365-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Vaccinated patient deceased from COVID."
	"1636482-1"	"1636482-1"	"CARDIAC FAILURE"	"10007554"	"65-79 years"	"65-79"	"Admitted on 8/18/21 for hypoxia, COVID +, and was found to have heart failure exacerbation, UTI, COVID pneumonia. Worsening compensation transferred to ICU for hypoxia and max Vapotherm. pt. taking dexamethasone and remdesivir. Patient DNR/DNI . Not a candidate for monoclonal antibody due to strep pneumonia positive infection. Given supportive care with death on 8/25/21."
	"1636482-1"	"1636482-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Admitted on 8/18/21 for hypoxia, COVID +, and was found to have heart failure exacerbation, UTI, COVID pneumonia. Worsening compensation transferred to ICU for hypoxia and max Vapotherm. pt. taking dexamethasone and remdesivir. Patient DNR/DNI . Not a candidate for monoclonal antibody due to strep pneumonia positive infection. Given supportive care with death on 8/25/21."
	"1636482-1"	"1636482-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Admitted on 8/18/21 for hypoxia, COVID +, and was found to have heart failure exacerbation, UTI, COVID pneumonia. Worsening compensation transferred to ICU for hypoxia and max Vapotherm. pt. taking dexamethasone and remdesivir. Patient DNR/DNI . Not a candidate for monoclonal antibody due to strep pneumonia positive infection. Given supportive care with death on 8/25/21."
	"1636482-1"	"1636482-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Admitted on 8/18/21 for hypoxia, COVID +, and was found to have heart failure exacerbation, UTI, COVID pneumonia. Worsening compensation transferred to ICU for hypoxia and max Vapotherm. pt. taking dexamethasone and remdesivir. Patient DNR/DNI . Not a candidate for monoclonal antibody due to strep pneumonia positive infection. Given supportive care with death on 8/25/21."
	"1636482-1"	"1636482-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Admitted on 8/18/21 for hypoxia, COVID +, and was found to have heart failure exacerbation, UTI, COVID pneumonia. Worsening compensation transferred to ICU for hypoxia and max Vapotherm. pt. taking dexamethasone and remdesivir. Patient DNR/DNI . Not a candidate for monoclonal antibody due to strep pneumonia positive infection. Given supportive care with death on 8/25/21."
	"1636482-1"	"1636482-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Admitted on 8/18/21 for hypoxia, COVID +, and was found to have heart failure exacerbation, UTI, COVID pneumonia. Worsening compensation transferred to ICU for hypoxia and max Vapotherm. pt. taking dexamethasone and remdesivir. Patient DNR/DNI . Not a candidate for monoclonal antibody due to strep pneumonia positive infection. Given supportive care with death on 8/25/21."
	"1636482-1"	"1636482-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Admitted on 8/18/21 for hypoxia, COVID +, and was found to have heart failure exacerbation, UTI, COVID pneumonia. Worsening compensation transferred to ICU for hypoxia and max Vapotherm. pt. taking dexamethasone and remdesivir. Patient DNR/DNI . Not a candidate for monoclonal antibody due to strep pneumonia positive infection. Given supportive care with death on 8/25/21."
	"1636482-1"	"1636482-1"	"PNEUMONIA STREPTOCOCCAL"	"10035735"	"65-79 years"	"65-79"	"Admitted on 8/18/21 for hypoxia, COVID +, and was found to have heart failure exacerbation, UTI, COVID pneumonia. Worsening compensation transferred to ICU for hypoxia and max Vapotherm. pt. taking dexamethasone and remdesivir. Patient DNR/DNI . Not a candidate for monoclonal antibody due to strep pneumonia positive infection. Given supportive care with death on 8/25/21."
	"1636482-1"	"1636482-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Admitted on 8/18/21 for hypoxia, COVID +, and was found to have heart failure exacerbation, UTI, COVID pneumonia. Worsening compensation transferred to ICU for hypoxia and max Vapotherm. pt. taking dexamethasone and remdesivir. Patient DNR/DNI . Not a candidate for monoclonal antibody due to strep pneumonia positive infection. Given supportive care with death on 8/25/21."
	"1636482-1"	"1636482-1"	"STREPTOCOCCUS TEST POSITIVE"	"10070055"	"65-79 years"	"65-79"	"Admitted on 8/18/21 for hypoxia, COVID +, and was found to have heart failure exacerbation, UTI, COVID pneumonia. Worsening compensation transferred to ICU for hypoxia and max Vapotherm. pt. taking dexamethasone and remdesivir. Patient DNR/DNI . Not a candidate for monoclonal antibody due to strep pneumonia positive infection. Given supportive care with death on 8/25/21."
	"1636482-1"	"1636482-1"	"URINARY TRACT INFECTION"	"10046571"	"65-79 years"	"65-79"	"Admitted on 8/18/21 for hypoxia, COVID +, and was found to have heart failure exacerbation, UTI, COVID pneumonia. Worsening compensation transferred to ICU for hypoxia and max Vapotherm. pt. taking dexamethasone and remdesivir. Patient DNR/DNI . Not a candidate for monoclonal antibody due to strep pneumonia positive infection. Given supportive care with death on 8/25/21."
	"1636496-1"	"1636496-1"	"ATRIAL FIBRILLATION"	"10003658"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"DIARRHOEA"	"10012735"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"PLEURITIC PAIN"	"10035623"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1636496-1"	"1636496-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME.  8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED.  REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER.  8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE.  PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST.  8/25/21 PATIENT DIED."
	"1637847-1"	"1637847-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death. Unknown"
	"1641372-1"	"1641372-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"PT IS A BREAKTHROUGH CASE OF COVID-19. PT EXPIRED ON 8/24/2021."
	"1641372-1"	"1641372-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"PT IS A BREAKTHROUGH CASE OF COVID-19. PT EXPIRED ON 8/24/2021."
	"1641372-1"	"1641372-1"	"INFECTION"	"10021789"	"65-79 years"	"65-79"	"PT IS A BREAKTHROUGH CASE OF COVID-19. PT EXPIRED ON 8/24/2021."
	"1646822-1"	"1646822-1"	"ANOSMIA"	"10002653"	"65-79 years"	"65-79"	"Subdural hem; Tiredness; Loss of appetite; Loss of smell; This is a spontaneous report from two contactable consumers (one of was patient's wife). A 76-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) intramuscular, administered in Deltoid Left on 26Feb2021 16:00 (Lot Number: EN6205) as dose 2, single (at age of 76-year-old) for covid-19 immunisation. Prior Vaccinations was none. Medical history included blood pressure abnormal, chronic obstructive pulmonary disease (COPD), cholesterol abnormal. Concomitant medications included lisinopril taken for blood pressure abnormal from an unspecified date to 22May2021; salbutamol sulfate (PROAIR HFA) via Inhalation route taken for COPD from an unspecified date to 22May2021; pravastatin taken for cholesterol abnormal from 2019 to 21May2021. Historical Vaccine included the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot number: EL9265) Intramuscular administered in Right deltoid on 02Feb2021 08:45 AM for COVID-19 immunisation (at age of 76-year-old) and experienced flu like, sweats, chills, fever, vomiting, extreme tiredness, ill. The patient experienced subdural hem (death, medically significant) on 23May2021, week long tiredness on 2021, loss of appetite on 2021, loss of smell on 2021. The second dose resulted in week long tiredness, loss of appetite, loss of smell. The event subdural hem required visit to Emergency room and had no treatment. The patient died on 24May2021. An autopsy was not performed. Outcome of the event subdural hem was fatal, of the events tiredness, loss of appetite, loss of smell was unknown.     Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: Subdural hem"
	"1646822-1"	"1646822-1"	"DECREASED APPETITE"	"10061428"	"65-79 years"	"65-79"	"Subdural hem; Tiredness; Loss of appetite; Loss of smell; This is a spontaneous report from two contactable consumers (one of was patient's wife). A 76-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) intramuscular, administered in Deltoid Left on 26Feb2021 16:00 (Lot Number: EN6205) as dose 2, single (at age of 76-year-old) for covid-19 immunisation. Prior Vaccinations was none. Medical history included blood pressure abnormal, chronic obstructive pulmonary disease (COPD), cholesterol abnormal. Concomitant medications included lisinopril taken for blood pressure abnormal from an unspecified date to 22May2021; salbutamol sulfate (PROAIR HFA) via Inhalation route taken for COPD from an unspecified date to 22May2021; pravastatin taken for cholesterol abnormal from 2019 to 21May2021. Historical Vaccine included the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot number: EL9265) Intramuscular administered in Right deltoid on 02Feb2021 08:45 AM for COVID-19 immunisation (at age of 76-year-old) and experienced flu like, sweats, chills, fever, vomiting, extreme tiredness, ill. The patient experienced subdural hem (death, medically significant) on 23May2021, week long tiredness on 2021, loss of appetite on 2021, loss of smell on 2021. The second dose resulted in week long tiredness, loss of appetite, loss of smell. The event subdural hem required visit to Emergency room and had no treatment. The patient died on 24May2021. An autopsy was not performed. Outcome of the event subdural hem was fatal, of the events tiredness, loss of appetite, loss of smell was unknown.     Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: Subdural hem"
	"1646822-1"	"1646822-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"Subdural hem; Tiredness; Loss of appetite; Loss of smell; This is a spontaneous report from two contactable consumers (one of was patient's wife). A 76-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) intramuscular, administered in Deltoid Left on 26Feb2021 16:00 (Lot Number: EN6205) as dose 2, single (at age of 76-year-old) for covid-19 immunisation. Prior Vaccinations was none. Medical history included blood pressure abnormal, chronic obstructive pulmonary disease (COPD), cholesterol abnormal. Concomitant medications included lisinopril taken for blood pressure abnormal from an unspecified date to 22May2021; salbutamol sulfate (PROAIR HFA) via Inhalation route taken for COPD from an unspecified date to 22May2021; pravastatin taken for cholesterol abnormal from 2019 to 21May2021. Historical Vaccine included the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot number: EL9265) Intramuscular administered in Right deltoid on 02Feb2021 08:45 AM for COVID-19 immunisation (at age of 76-year-old) and experienced flu like, sweats, chills, fever, vomiting, extreme tiredness, ill. The patient experienced subdural hem (death, medically significant) on 23May2021, week long tiredness on 2021, loss of appetite on 2021, loss of smell on 2021. The second dose resulted in week long tiredness, loss of appetite, loss of smell. The event subdural hem required visit to Emergency room and had no treatment. The patient died on 24May2021. An autopsy was not performed. Outcome of the event subdural hem was fatal, of the events tiredness, loss of appetite, loss of smell was unknown.     Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: Subdural hem"
	"1646822-1"	"1646822-1"	"SUBDURAL HAEMATOMA"	"10042361"	"65-79 years"	"65-79"	"Subdural hem; Tiredness; Loss of appetite; Loss of smell; This is a spontaneous report from two contactable consumers (one of was patient's wife). A 76-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) intramuscular, administered in Deltoid Left on 26Feb2021 16:00 (Lot Number: EN6205) as dose 2, single (at age of 76-year-old) for covid-19 immunisation. Prior Vaccinations was none. Medical history included blood pressure abnormal, chronic obstructive pulmonary disease (COPD), cholesterol abnormal. Concomitant medications included lisinopril taken for blood pressure abnormal from an unspecified date to 22May2021; salbutamol sulfate (PROAIR HFA) via Inhalation route taken for COPD from an unspecified date to 22May2021; pravastatin taken for cholesterol abnormal from 2019 to 21May2021. Historical Vaccine included the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot number: EL9265) Intramuscular administered in Right deltoid on 02Feb2021 08:45 AM for COVID-19 immunisation (at age of 76-year-old) and experienced flu like, sweats, chills, fever, vomiting, extreme tiredness, ill. The patient experienced subdural hem (death, medically significant) on 23May2021, week long tiredness on 2021, loss of appetite on 2021, loss of smell on 2021. The second dose resulted in week long tiredness, loss of appetite, loss of smell. The event subdural hem required visit to Emergency room and had no treatment. The patient died on 24May2021. An autopsy was not performed. Outcome of the event subdural hem was fatal, of the events tiredness, loss of appetite, loss of smell was unknown.     Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: Subdural hem"
	"1651302-1"	"1651302-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received second dose of covid 19 moderna vaccine March 30 2021 and he died exactly 2 months after that second dose.  He died in the shower chair during his shower."
	"1655701-1"	"1655701-1"	"BRONCHIAL DISORDER"	"10064913"	"65-79 years"	"65-79"	"Was in hospital initially on 8/6-10 with covid pneumonia. Treated with antibiotics and steroids with improvement. Discharged with antibiotics, steroids, and home oxygen. Readmitted on 8/14 with worsening shortness of breath. Elevated inflammatory markers (fibrinogen,, D-dimer and CRP). Developed pneumomediastinum with peribronchial preponderance. CT surgery evaluated and did not recommend surgical intervention. Treated with broad spectrum antibiotics and steroids."
	"1655701-1"	"1655701-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Was in hospital initially on 8/6-10 with covid pneumonia. Treated with antibiotics and steroids with improvement. Discharged with antibiotics, steroids, and home oxygen. Readmitted on 8/14 with worsening shortness of breath. Elevated inflammatory markers (fibrinogen,, D-dimer and CRP). Developed pneumomediastinum with peribronchial preponderance. CT surgery evaluated and did not recommend surgical intervention. Treated with broad spectrum antibiotics and steroids."
	"1655701-1"	"1655701-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Was in hospital initially on 8/6-10 with covid pneumonia. Treated with antibiotics and steroids with improvement. Discharged with antibiotics, steroids, and home oxygen. Readmitted on 8/14 with worsening shortness of breath. Elevated inflammatory markers (fibrinogen,, D-dimer and CRP). Developed pneumomediastinum with peribronchial preponderance. CT surgery evaluated and did not recommend surgical intervention. Treated with broad spectrum antibiotics and steroids."
	"1655701-1"	"1655701-1"	"INFLAMMATORY MARKER INCREASED"	"10069826"	"65-79 years"	"65-79"	"Was in hospital initially on 8/6-10 with covid pneumonia. Treated with antibiotics and steroids with improvement. Discharged with antibiotics, steroids, and home oxygen. Readmitted on 8/14 with worsening shortness of breath. Elevated inflammatory markers (fibrinogen,, D-dimer and CRP). Developed pneumomediastinum with peribronchial preponderance. CT surgery evaluated and did not recommend surgical intervention. Treated with broad spectrum antibiotics and steroids."
	"1655701-1"	"1655701-1"	"PNEUMOMEDIASTINUM"	"10050184"	"65-79 years"	"65-79"	"Was in hospital initially on 8/6-10 with covid pneumonia. Treated with antibiotics and steroids with improvement. Discharged with antibiotics, steroids, and home oxygen. Readmitted on 8/14 with worsening shortness of breath. Elevated inflammatory markers (fibrinogen,, D-dimer and CRP). Developed pneumomediastinum with peribronchial preponderance. CT surgery evaluated and did not recommend surgical intervention. Treated with broad spectrum antibiotics and steroids."
	"1656270-1"	"1656270-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Case was fully vaccinated with COVID 19 vaccine. Last dose administered on 2/5/21. Case tested positive for COVID 19 on 8/4/2021. and was admitted to Medical Center with covid signs and symptoms on 8/11/2021. Case expired while still hospitalized on 8/26/2021."
	"1656270-1"	"1656270-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Case was fully vaccinated with COVID 19 vaccine. Last dose administered on 2/5/21. Case tested positive for COVID 19 on 8/4/2021. and was admitted to Medical Center with covid signs and symptoms on 8/11/2021. Case expired while still hospitalized on 8/26/2021."
	"1656270-1"	"1656270-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Case was fully vaccinated with COVID 19 vaccine. Last dose administered on 2/5/21. Case tested positive for COVID 19 on 8/4/2021. and was admitted to Medical Center with covid signs and symptoms on 8/11/2021. Case expired while still hospitalized on 8/26/2021."
	"1656294-1"	"1656294-1"	"ATELECTASIS"	"10003598"	"65-79 years"	"65-79"	"Presented to ED with difficulty breathing, O2 saturation 60% on room air. continued to have increased work of breathing and intubated and placed on mechanical ventilation.  + Covid-19 test. Required vasopressor support with levophed. Found to have pseudomonas pneumonia. Multisystem organ failure and family requested transition to comfort care and passed on 8/29/21."
	"1656294-1"	"1656294-1"	"COMPUTERISED TOMOGRAM THORAX ABNORMAL"	"10057799"	"65-79 years"	"65-79"	"Presented to ED with difficulty breathing, O2 saturation 60% on room air. continued to have increased work of breathing and intubated and placed on mechanical ventilation.  + Covid-19 test. Required vasopressor support with levophed. Found to have pseudomonas pneumonia. Multisystem organ failure and family requested transition to comfort care and passed on 8/29/21."
	"1656294-1"	"1656294-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Presented to ED with difficulty breathing, O2 saturation 60% on room air. continued to have increased work of breathing and intubated and placed on mechanical ventilation.  + Covid-19 test. Required vasopressor support with levophed. Found to have pseudomonas pneumonia. Multisystem organ failure and family requested transition to comfort care and passed on 8/29/21."
	"1656294-1"	"1656294-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Presented to ED with difficulty breathing, O2 saturation 60% on room air. continued to have increased work of breathing and intubated and placed on mechanical ventilation.  + Covid-19 test. Required vasopressor support with levophed. Found to have pseudomonas pneumonia. Multisystem organ failure and family requested transition to comfort care and passed on 8/29/21."
	"1656294-1"	"1656294-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Presented to ED with difficulty breathing, O2 saturation 60% on room air. continued to have increased work of breathing and intubated and placed on mechanical ventilation.  + Covid-19 test. Required vasopressor support with levophed. Found to have pseudomonas pneumonia. Multisystem organ failure and family requested transition to comfort care and passed on 8/29/21."
	"1656294-1"	"1656294-1"	"LUNG HYPERINFLATION"	"10059487"	"65-79 years"	"65-79"	"Presented to ED with difficulty breathing, O2 saturation 60% on room air. continued to have increased work of breathing and intubated and placed on mechanical ventilation.  + Covid-19 test. Required vasopressor support with levophed. Found to have pseudomonas pneumonia. Multisystem organ failure and family requested transition to comfort care and passed on 8/29/21."
	"1656294-1"	"1656294-1"	"LUNG OPACITY"	"10081792"	"65-79 years"	"65-79"	"Presented to ED with difficulty breathing, O2 saturation 60% on room air. continued to have increased work of breathing and intubated and placed on mechanical ventilation.  + Covid-19 test. Required vasopressor support with levophed. Found to have pseudomonas pneumonia. Multisystem organ failure and family requested transition to comfort care and passed on 8/29/21."
	"1656294-1"	"1656294-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Presented to ED with difficulty breathing, O2 saturation 60% on room air. continued to have increased work of breathing and intubated and placed on mechanical ventilation.  + Covid-19 test. Required vasopressor support with levophed. Found to have pseudomonas pneumonia. Multisystem organ failure and family requested transition to comfort care and passed on 8/29/21."
	"1656294-1"	"1656294-1"	"MULTIPLE ORGAN DYSFUNCTION SYNDROME"	"10077361"	"65-79 years"	"65-79"	"Presented to ED with difficulty breathing, O2 saturation 60% on room air. continued to have increased work of breathing and intubated and placed on mechanical ventilation.  + Covid-19 test. Required vasopressor support with levophed. Found to have pseudomonas pneumonia. Multisystem organ failure and family requested transition to comfort care and passed on 8/29/21."
	"1656294-1"	"1656294-1"	"PNEUMONIA PSEUDOMONAL"	"10035731"	"65-79 years"	"65-79"	"Presented to ED with difficulty breathing, O2 saturation 60% on room air. continued to have increased work of breathing and intubated and placed on mechanical ventilation.  + Covid-19 test. Required vasopressor support with levophed. Found to have pseudomonas pneumonia. Multisystem organ failure and family requested transition to comfort care and passed on 8/29/21."
	"1656294-1"	"1656294-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Presented to ED with difficulty breathing, O2 saturation 60% on room air. continued to have increased work of breathing and intubated and placed on mechanical ventilation.  + Covid-19 test. Required vasopressor support with levophed. Found to have pseudomonas pneumonia. Multisystem organ failure and family requested transition to comfort care and passed on 8/29/21."
	"1659718-1"	"1659718-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"Pulmonary Embolism, Acute Respiratory Failure, and Death"
	"1659718-1"	"1659718-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pulmonary Embolism, Acute Respiratory Failure, and Death"
	"1659718-1"	"1659718-1"	"PULMONARY EMBOLISM"	"10037377"	"65-79 years"	"65-79"	"Pulmonary Embolism, Acute Respiratory Failure, and Death"
	"1662120-1"	"1662120-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"DEATH"
	"1662188-1"	"1662188-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"PT IS A BREAKTHROUGH CASE OF COVID-19 THAT EXPIRED ON 9/1/2021."
	"1662188-1"	"1662188-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"PT IS A BREAKTHROUGH CASE OF COVID-19 THAT EXPIRED ON 9/1/2021."
	"1662188-1"	"1662188-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"PT IS A BREAKTHROUGH CASE OF COVID-19 THAT EXPIRED ON 9/1/2021."
	"1662918-1"	"1662918-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"cough, SOB, nausea x 7 days prior to hospital admission"
	"1662918-1"	"1662918-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"cough, SOB, nausea x 7 days prior to hospital admission"
	"1662918-1"	"1662918-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"cough, SOB, nausea x 7 days prior to hospital admission"
	"1662980-1"	"1662980-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"coughing, wheezing, O2 sat of 80%"
	"1662980-1"	"1662980-1"	"WHEEZING"	"10047924"	"65-79 years"	"65-79"	"coughing, wheezing, O2 sat of 80%"
	"1666125-1"	"1666125-1"	"CONFUSIONAL STATE"	"10010305"	"65-79 years"	"65-79"	"cough, SOB, hypoxia, confusion"
	"1666125-1"	"1666125-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"cough, SOB, hypoxia, confusion"
	"1666125-1"	"1666125-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"cough, SOB, hypoxia, confusion"
	"1666125-1"	"1666125-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"cough, SOB, hypoxia, confusion"
	"1666125-1"	"1666125-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"cough, SOB, hypoxia, confusion"
	"1666430-1"	"1666430-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient fully vaccinated with two COVID 19 vaccines. Admitted to Hospital on 08/20/2021 with COVID 19. Case expired on 08/31/2021 while still hospitalized."
	"1666430-1"	"1666430-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient fully vaccinated with two COVID 19 vaccines. Admitted to Hospital on 08/20/2021 with COVID 19. Case expired on 08/31/2021 while still hospitalized."
	"1666824-1"	"1666824-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Unknown"
	"1670809-1"	"1670809-1"	"CEREBROVASCULAR ACCIDENT"	"10008190"	"65-79 years"	"65-79"	"Positive COVID test, dementia, CVA, CKD3, seizure disorder"
	"1670809-1"	"1670809-1"	"CHRONIC KIDNEY DISEASE"	"10064848"	"65-79 years"	"65-79"	"Positive COVID test, dementia, CVA, CKD3, seizure disorder"
	"1670809-1"	"1670809-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Positive COVID test, dementia, CVA, CKD3, seizure disorder"
	"1670809-1"	"1670809-1"	"DEMENTIA"	"10012267"	"65-79 years"	"65-79"	"Positive COVID test, dementia, CVA, CKD3, seizure disorder"
	"1670809-1"	"1670809-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Positive COVID test, dementia, CVA, CKD3, seizure disorder"
	"1670809-1"	"1670809-1"	"SEIZURE"	"10039906"	"65-79 years"	"65-79"	"Positive COVID test, dementia, CVA, CKD3, seizure disorder"
	"1672600-1"	"1672600-1"	"MYOCARDIAL INFARCTION"	"10028596"	"65-79 years"	"65-79"	"Heart attack; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Heart attack) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination.     Concomitant products included ATORVASTATIN CALCIUM (STATIN [ATORVASTATIN CALCIUM]) for an unknown indication.    On 12-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 14-Mar-2021, the patient experienced MYOCARDIAL INFARCTION (Heart attack) (seriousness criteria death and medically significant). The patient died on 14-Mar-2021. The reported cause of death was Heart attack. An autopsy was not performed.            Treatment information was not provided.  Company comment Very limited information regarding this event/s has been provided at this time.  Further information has been requested   Most recent FOLLOW-UP information incorporated above includes: On 20-Aug-2021: Follow-up received and contains reporter contact information.; Sender's Comments: Very limited information regarding this event/s has been provided at this time.  Further information has been requested; Reported Cause(s) of Death: Heart attack"
	"1678487-1"	"1678487-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Death due to COVID-19"
	"1678487-1"	"1678487-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death due to COVID-19"
	"1678562-1"	"1678562-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"PT EXPIRED FROM COVID-19 ON 9/5/2021; BREAKTHROUGH CASE"
	"1678562-1"	"1678562-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"PT EXPIRED FROM COVID-19 ON 9/5/2021; BREAKTHROUGH CASE"
	"1678562-1"	"1678562-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"PT EXPIRED FROM COVID-19 ON 9/5/2021; BREAKTHROUGH CASE"
	"1678597-1"	"1678597-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31.  on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures."
	"1678597-1"	"1678597-1"	"ARTHRALGIA"	"10003239"	"65-79 years"	"65-79"	"Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31.  on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures."
	"1678597-1"	"1678597-1"	"CARDIAC FAILURE"	"10007554"	"65-79 years"	"65-79"	"Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31.  on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures."
	"1678597-1"	"1678597-1"	"COMPUTERISED TOMOGRAM ABNORMAL"	"10010235"	"65-79 years"	"65-79"	"Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31.  on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures."
	"1678597-1"	"1678597-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31.  on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures."
	"1678597-1"	"1678597-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31.  on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures."
	"1678597-1"	"1678597-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31.  on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures."
	"1678597-1"	"1678597-1"	"DECREASED APPETITE"	"10061428"	"65-79 years"	"65-79"	"Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31.  on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures."
	"1678597-1"	"1678597-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31.  on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures."
	"1678597-1"	"1678597-1"	"ELECTROLYTE IMBALANCE"	"10014418"	"65-79 years"	"65-79"	"Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31.  on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures."
	"1678597-1"	"1678597-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31.  on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures."
	"1678597-1"	"1678597-1"	"EXPOSURE TO SARS-COV-2"	"10084456"	"65-79 years"	"65-79"	"Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31.  on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures."
	"1678597-1"	"1678597-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31.  on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures."
	"1678597-1"	"1678597-1"	"RETROPERITONEAL HAEMORRHAGE"	"10038980"	"65-79 years"	"65-79"	"Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31.  on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures."
	"1678597-1"	"1678597-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31.  on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures."
	"1678597-1"	"1678597-1"	"TRANSFUSION"	"10066152"	"65-79 years"	"65-79"	"Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31.  on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures."
	"1682464-1"	"1682464-1"	"ACUTE MYOCARDIAL INFARCTION"	"10000891"	"65-79 years"	"65-79"	"Diagnosed with COVID on 8/27 at outside hospital after cough, shortness of breath and diarrhea x 2 weeks. Treated with steroids and remdesivir. Transferred to Medical Center on 9/2 with COVID pneumonia and intubated. continued to decline with increased respiratory support, septic shock, dual pressors and worsening renal failure. Developed new Afib and EKG showed evidence of acute MI/mycardial injury. Multi organ system failure. 9/7 family chose comfort care."
	"1682464-1"	"1682464-1"	"ATRIAL FIBRILLATION"	"10003658"	"65-79 years"	"65-79"	"Diagnosed with COVID on 8/27 at outside hospital after cough, shortness of breath and diarrhea x 2 weeks. Treated with steroids and remdesivir. Transferred to Medical Center on 9/2 with COVID pneumonia and intubated. continued to decline with increased respiratory support, septic shock, dual pressors and worsening renal failure. Developed new Afib and EKG showed evidence of acute MI/mycardial injury. Multi organ system failure. 9/7 family chose comfort care."
	"1682464-1"	"1682464-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Diagnosed with COVID on 8/27 at outside hospital after cough, shortness of breath and diarrhea x 2 weeks. Treated with steroids and remdesivir. Transferred to Medical Center on 9/2 with COVID pneumonia and intubated. continued to decline with increased respiratory support, septic shock, dual pressors and worsening renal failure. Developed new Afib and EKG showed evidence of acute MI/mycardial injury. Multi organ system failure. 9/7 family chose comfort care."
	"1682464-1"	"1682464-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Diagnosed with COVID on 8/27 at outside hospital after cough, shortness of breath and diarrhea x 2 weeks. Treated with steroids and remdesivir. Transferred to Medical Center on 9/2 with COVID pneumonia and intubated. continued to decline with increased respiratory support, septic shock, dual pressors and worsening renal failure. Developed new Afib and EKG showed evidence of acute MI/mycardial injury. Multi organ system failure. 9/7 family chose comfort care."
	"1682464-1"	"1682464-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Diagnosed with COVID on 8/27 at outside hospital after cough, shortness of breath and diarrhea x 2 weeks. Treated with steroids and remdesivir. Transferred to Medical Center on 9/2 with COVID pneumonia and intubated. continued to decline with increased respiratory support, septic shock, dual pressors and worsening renal failure. Developed new Afib and EKG showed evidence of acute MI/mycardial injury. Multi organ system failure. 9/7 family chose comfort care."
	"1682464-1"	"1682464-1"	"DIARRHOEA"	"10012735"	"65-79 years"	"65-79"	"Diagnosed with COVID on 8/27 at outside hospital after cough, shortness of breath and diarrhea x 2 weeks. Treated with steroids and remdesivir. Transferred to Medical Center on 9/2 with COVID pneumonia and intubated. continued to decline with increased respiratory support, septic shock, dual pressors and worsening renal failure. Developed new Afib and EKG showed evidence of acute MI/mycardial injury. Multi organ system failure. 9/7 family chose comfort care."
	"1682464-1"	"1682464-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Diagnosed with COVID on 8/27 at outside hospital after cough, shortness of breath and diarrhea x 2 weeks. Treated with steroids and remdesivir. Transferred to Medical Center on 9/2 with COVID pneumonia and intubated. continued to decline with increased respiratory support, septic shock, dual pressors and worsening renal failure. Developed new Afib and EKG showed evidence of acute MI/mycardial injury. Multi organ system failure. 9/7 family chose comfort care."
	"1682464-1"	"1682464-1"	"ELECTROCARDIOGRAM ABNORMAL"	"10014363"	"65-79 years"	"65-79"	"Diagnosed with COVID on 8/27 at outside hospital after cough, shortness of breath and diarrhea x 2 weeks. Treated with steroids and remdesivir. Transferred to Medical Center on 9/2 with COVID pneumonia and intubated. continued to decline with increased respiratory support, septic shock, dual pressors and worsening renal failure. Developed new Afib and EKG showed evidence of acute MI/mycardial injury. Multi organ system failure. 9/7 family chose comfort care."
	"1682464-1"	"1682464-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Diagnosed with COVID on 8/27 at outside hospital after cough, shortness of breath and diarrhea x 2 weeks. Treated with steroids and remdesivir. Transferred to Medical Center on 9/2 with COVID pneumonia and intubated. continued to decline with increased respiratory support, septic shock, dual pressors and worsening renal failure. Developed new Afib and EKG showed evidence of acute MI/mycardial injury. Multi organ system failure. 9/7 family chose comfort care."
	"1682464-1"	"1682464-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Diagnosed with COVID on 8/27 at outside hospital after cough, shortness of breath and diarrhea x 2 weeks. Treated with steroids and remdesivir. Transferred to Medical Center on 9/2 with COVID pneumonia and intubated. continued to decline with increased respiratory support, septic shock, dual pressors and worsening renal failure. Developed new Afib and EKG showed evidence of acute MI/mycardial injury. Multi organ system failure. 9/7 family chose comfort care."
	"1682464-1"	"1682464-1"	"MULTIPLE ORGAN DYSFUNCTION SYNDROME"	"10077361"	"65-79 years"	"65-79"	"Diagnosed with COVID on 8/27 at outside hospital after cough, shortness of breath and diarrhea x 2 weeks. Treated with steroids and remdesivir. Transferred to Medical Center on 9/2 with COVID pneumonia and intubated. continued to decline with increased respiratory support, septic shock, dual pressors and worsening renal failure. Developed new Afib and EKG showed evidence of acute MI/mycardial injury. Multi organ system failure. 9/7 family chose comfort care."
	"1682464-1"	"1682464-1"	"MYOCARDIAL INJURY"	"10085879"	"65-79 years"	"65-79"	"Diagnosed with COVID on 8/27 at outside hospital after cough, shortness of breath and diarrhea x 2 weeks. Treated with steroids and remdesivir. Transferred to Medical Center on 9/2 with COVID pneumonia and intubated. continued to decline with increased respiratory support, septic shock, dual pressors and worsening renal failure. Developed new Afib and EKG showed evidence of acute MI/mycardial injury. Multi organ system failure. 9/7 family chose comfort care."
	"1682464-1"	"1682464-1"	"RENAL FAILURE"	"10038435"	"65-79 years"	"65-79"	"Diagnosed with COVID on 8/27 at outside hospital after cough, shortness of breath and diarrhea x 2 weeks. Treated with steroids and remdesivir. Transferred to Medical Center on 9/2 with COVID pneumonia and intubated. continued to decline with increased respiratory support, septic shock, dual pressors and worsening renal failure. Developed new Afib and EKG showed evidence of acute MI/mycardial injury. Multi organ system failure. 9/7 family chose comfort care."
	"1682464-1"	"1682464-1"	"SEPTIC SHOCK"	"10040070"	"65-79 years"	"65-79"	"Diagnosed with COVID on 8/27 at outside hospital after cough, shortness of breath and diarrhea x 2 weeks. Treated with steroids and remdesivir. Transferred to Medical Center on 9/2 with COVID pneumonia and intubated. continued to decline with increased respiratory support, septic shock, dual pressors and worsening renal failure. Developed new Afib and EKG showed evidence of acute MI/mycardial injury. Multi organ system failure. 9/7 family chose comfort care."
	"1682712-1"	"1682712-1"	"CARDIAC FAILURE CONGESTIVE"	"10007559"	"65-79 years"	"65-79"	"Approx 14 hours post-vaccination, patient's wife awoke to her husband struggling to breath. EMT was called, and he was transported to the hospital ED and passed away. ED physician believed death was related to CHF and not directly related to the Moderna vaccine."
	"1682712-1"	"1682712-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Approx 14 hours post-vaccination, patient's wife awoke to her husband struggling to breath. EMT was called, and he was transported to the hospital ED and passed away. ED physician believed death was related to CHF and not directly related to the Moderna vaccine."
	"1682712-1"	"1682712-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Approx 14 hours post-vaccination, patient's wife awoke to her husband struggling to breath. EMT was called, and he was transported to the hospital ED and passed away. ED physician believed death was related to CHF and not directly related to the Moderna vaccine."
	"1682712-1"	"1682712-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Approx 14 hours post-vaccination, patient's wife awoke to her husband struggling to breath. EMT was called, and he was transported to the hospital ED and passed away. ED physician believed death was related to CHF and not directly related to the Moderna vaccine."
	"1689354-1"	"1689354-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient fully vaccinated with Pfizer vaccine x doses. Tested positive for COVID 19 on 8/6/2021 and died at home on 8/20/2021."
	"1689354-1"	"1689354-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient fully vaccinated with Pfizer vaccine x doses. Tested positive for COVID 19 on 8/6/2021 and died at home on 8/20/2021."
	"1689354-1"	"1689354-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient fully vaccinated with Pfizer vaccine x doses. Tested positive for COVID 19 on 8/6/2021 and died at home on 8/20/2021."
	"1689377-1"	"1689377-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer. Last dose on 3/4/21. Tested positive for COVID on 8/11/2021. Admitted to  Community Hospital East on 8/16/2021. Expired on 8/27/2021 while still hospitalized."
	"1689377-1"	"1689377-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer. Last dose on 3/4/21. Tested positive for COVID on 8/11/2021. Admitted to  Community Hospital East on 8/16/2021. Expired on 8/27/2021 while still hospitalized."
	"1689377-1"	"1689377-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer. Last dose on 3/4/21. Tested positive for COVID on 8/11/2021. Admitted to  Community Hospital East on 8/16/2021. Expired on 8/27/2021 while still hospitalized."
	"1689555-1"	"1689555-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"Presented to MC on 8/12 with progressive SOB, weakness and fatigue. Previously diagnosed with COVID.  Evidence of sepsis and pneumonia with increased O2 support. Given remdesivir, dexamethasone and broad spectrum antibiotics.  Due to long stay her isolation was discontinued and got first vaccination for COVID on 8/31.  On 9/2 experience recurrent respiratory decompensation. Again treated with steroids and antibiotics for pneumonia as well as dialysis. Respiratory status continued to decline and patient requested DNR/DNI with family agreeing to comfort care."
	"1689555-1"	"1689555-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Presented to MC on 8/12 with progressive SOB, weakness and fatigue. Previously diagnosed with COVID.  Evidence of sepsis and pneumonia with increased O2 support. Given remdesivir, dexamethasone and broad spectrum antibiotics.  Due to long stay her isolation was discontinued and got first vaccination for COVID on 8/31.  On 9/2 experience recurrent respiratory decompensation. Again treated with steroids and antibiotics for pneumonia as well as dialysis. Respiratory status continued to decline and patient requested DNR/DNI with family agreeing to comfort care."
	"1689555-1"	"1689555-1"	"DIALYSIS"	"10061105"	"65-79 years"	"65-79"	"Presented to MC on 8/12 with progressive SOB, weakness and fatigue. Previously diagnosed with COVID.  Evidence of sepsis and pneumonia with increased O2 support. Given remdesivir, dexamethasone and broad spectrum antibiotics.  Due to long stay her isolation was discontinued and got first vaccination for COVID on 8/31.  On 9/2 experience recurrent respiratory decompensation. Again treated with steroids and antibiotics for pneumonia as well as dialysis. Respiratory status continued to decline and patient requested DNR/DNI with family agreeing to comfort care."
	"1689555-1"	"1689555-1"	"PNEUMONIA"	"10035664"	"65-79 years"	"65-79"	"Presented to MC on 8/12 with progressive SOB, weakness and fatigue. Previously diagnosed with COVID.  Evidence of sepsis and pneumonia with increased O2 support. Given remdesivir, dexamethasone and broad spectrum antibiotics.  Due to long stay her isolation was discontinued and got first vaccination for COVID on 8/31.  On 9/2 experience recurrent respiratory decompensation. Again treated with steroids and antibiotics for pneumonia as well as dialysis. Respiratory status continued to decline and patient requested DNR/DNI with family agreeing to comfort care."
	"1692936-1"	"1692936-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	""complained of ""inflamed bowels"" on May 14,2021 then shortly expired that day.""
	"1692936-1"	"1692936-1"	"INFLAMMATORY BOWEL DISEASE"	"10021972"	"65-79 years"	"65-79"	""complained of ""inflamed bowels"" on May 14,2021 then shortly expired that day.""
	"1694308-1"	"1694308-1"	"AORTIC VALVE REPLACEMENT"	"10002916"	"65-79 years"	"65-79"	"Surgery was done at on 5/19/21 to replace her aortic valve. While other complications came up, all of the fixes worked. Everything was repaired. My Mother?s blood would not clot. They were unable to close her following surgery. They tried again over night to stop the bleeding but her blood would still not clot.  She had stopped all of her blood thinning medications days earlier than suggested prior to surgery.  She died the next morning.   Had her blood clotted I believe  she would be here today.  I believe her blood did not clot because of her two doses of this vaccine."
	"1694308-1"	"1694308-1"	"CARDIAC PROCEDURE COMPLICATION"	"10057461"	"65-79 years"	"65-79"	"Surgery was done at on 5/19/21 to replace her aortic valve. While other complications came up, all of the fixes worked. Everything was repaired. My Mother?s blood would not clot. They were unable to close her following surgery. They tried again over night to stop the bleeding but her blood would still not clot.  She had stopped all of her blood thinning medications days earlier than suggested prior to surgery.  She died the next morning.   Had her blood clotted I believe  she would be here today.  I believe her blood did not clot because of her two doses of this vaccine."
	"1694308-1"	"1694308-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Surgery was done at on 5/19/21 to replace her aortic valve. While other complications came up, all of the fixes worked. Everything was repaired. My Mother?s blood would not clot. They were unable to close her following surgery. They tried again over night to stop the bleeding but her blood would still not clot.  She had stopped all of her blood thinning medications days earlier than suggested prior to surgery.  She died the next morning.   Had her blood clotted I believe  she would be here today.  I believe her blood did not clot because of her two doses of this vaccine."
	"1694308-1"	"1694308-1"	"HAEMORRHAGE"	"10055798"	"65-79 years"	"65-79"	"Surgery was done at on 5/19/21 to replace her aortic valve. While other complications came up, all of the fixes worked. Everything was repaired. My Mother?s blood would not clot. They were unable to close her following surgery. They tried again over night to stop the bleeding but her blood would still not clot.  She had stopped all of her blood thinning medications days earlier than suggested prior to surgery.  She died the next morning.   Had her blood clotted I believe  she would be here today.  I believe her blood did not clot because of her two doses of this vaccine."
	"1694308-1"	"1694308-1"	"LABORATORY TEST"	"10059938"	"65-79 years"	"65-79"	"Surgery was done at on 5/19/21 to replace her aortic valve. While other complications came up, all of the fixes worked. Everything was repaired. My Mother?s blood would not clot. They were unable to close her following surgery. They tried again over night to stop the bleeding but her blood would still not clot.  She had stopped all of her blood thinning medications days earlier than suggested prior to surgery.  She died the next morning.   Had her blood clotted I believe  she would be here today.  I believe her blood did not clot because of her two doses of this vaccine."
	"1694308-1"	"1694308-1"	"SURGERY"	"10042609"	"65-79 years"	"65-79"	"Surgery was done at on 5/19/21 to replace her aortic valve. While other complications came up, all of the fixes worked. Everything was repaired. My Mother?s blood would not clot. They were unable to close her following surgery. They tried again over night to stop the bleeding but her blood would still not clot.  She had stopped all of her blood thinning medications days earlier than suggested prior to surgery.  She died the next morning.   Had her blood clotted I believe  she would be here today.  I believe her blood did not clot because of her two doses of this vaccine."
	"1694787-1"	"1694787-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"patient tested postive for covid and hospitalizied on 09/07/2021 . Patient expired 9/11/2021. unable to complete section 21 for patient died will not allow me to enter date."
	"1694787-1"	"1694787-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"patient tested postive for covid and hospitalizied on 09/07/2021 . Patient expired 9/11/2021. unable to complete section 21 for patient died will not allow me to enter date."
	"1694787-1"	"1694787-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"patient tested postive for covid and hospitalizied on 09/07/2021 . Patient expired 9/11/2021. unable to complete section 21 for patient died will not allow me to enter date."
	"1694811-1"	"1694811-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	""Patient reported being vaccinated with Moderna. However I was unable to find record of this vaccination. Admitted on 08/20/21 with COVID, acute respiratory failure, CKD stage 5, and possible UTI. Discharged on 08/23 but readmitted on 08/25 for worsening symptoms. Patient placed on high flow without improvement. Patient experienced 2 ""code"" events on 09/03 and expired.""
	"1694811-1"	"1694811-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"65-79 years"	"65-79"	""Patient reported being vaccinated with Moderna. However I was unable to find record of this vaccination. Admitted on 08/20/21 with COVID, acute respiratory failure, CKD stage 5, and possible UTI. Discharged on 08/23 but readmitted on 08/25 for worsening symptoms. Patient placed on high flow without improvement. Patient experienced 2 ""code"" events on 09/03 and expired.""
	"1694811-1"	"1694811-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	""Patient reported being vaccinated with Moderna. However I was unable to find record of this vaccination. Admitted on 08/20/21 with COVID, acute respiratory failure, CKD stage 5, and possible UTI. Discharged on 08/23 but readmitted on 08/25 for worsening symptoms. Patient placed on high flow without improvement. Patient experienced 2 ""code"" events on 09/03 and expired.""
	"1694811-1"	"1694811-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	""Patient reported being vaccinated with Moderna. However I was unable to find record of this vaccination. Admitted on 08/20/21 with COVID, acute respiratory failure, CKD stage 5, and possible UTI. Discharged on 08/23 but readmitted on 08/25 for worsening symptoms. Patient placed on high flow without improvement. Patient experienced 2 ""code"" events on 09/03 and expired.""
	"1694811-1"	"1694811-1"	"END STAGE RENAL DISEASE"	"10077512"	"65-79 years"	"65-79"	""Patient reported being vaccinated with Moderna. However I was unable to find record of this vaccination. Admitted on 08/20/21 with COVID, acute respiratory failure, CKD stage 5, and possible UTI. Discharged on 08/23 but readmitted on 08/25 for worsening symptoms. Patient placed on high flow without improvement. Patient experienced 2 ""code"" events on 09/03 and expired.""
	"1696901-1"	"1696901-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Hemorrhagic Stroke on 07/30/2021 died 08/03/2021"
	"1696901-1"	"1696901-1"	"HAEMORRHAGIC STROKE"	"10019016"	"65-79 years"	"65-79"	"Hemorrhagic Stroke on 07/30/2021 died 08/03/2021"
	"1700097-1"	"1700097-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"COVID RELATED DEATH; PT FULLY VACCINATED"
	"1700097-1"	"1700097-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"COVID RELATED DEATH; PT FULLY VACCINATED"
	"1700296-1"	"1700296-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"COVID RELATED DEATH; FULLY VACCINATED PT."
	"1700296-1"	"1700296-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"COVID RELATED DEATH; FULLY VACCINATED PT."
	"1700712-1"	"1700712-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient presented to hospital in full trauma alert after motorcycle crash on 9/8. Intubated with subarachnoid hemorrhage with base skull fracture and multiple other fractures. Covid test +. No improvement with multiple trauma appropriate treatments. Family agreed with comfort care on 9/13."
	"1700712-1"	"1700712-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Patient presented to hospital in full trauma alert after motorcycle crash on 9/8. Intubated with subarachnoid hemorrhage with base skull fracture and multiple other fractures. Covid test +. No improvement with multiple trauma appropriate treatments. Family agreed with comfort care on 9/13."
	"1700712-1"	"1700712-1"	"INJURY"	"10022116"	"65-79 years"	"65-79"	"Patient presented to hospital in full trauma alert after motorcycle crash on 9/8. Intubated with subarachnoid hemorrhage with base skull fracture and multiple other fractures. Covid test +. No improvement with multiple trauma appropriate treatments. Family agreed with comfort care on 9/13."
	"1700712-1"	"1700712-1"	"MULTIPLE FRACTURES"	"10028200"	"65-79 years"	"65-79"	"Patient presented to hospital in full trauma alert after motorcycle crash on 9/8. Intubated with subarachnoid hemorrhage with base skull fracture and multiple other fractures. Covid test +. No improvement with multiple trauma appropriate treatments. Family agreed with comfort care on 9/13."
	"1700712-1"	"1700712-1"	"ROAD TRAFFIC ACCIDENT"	"10039203"	"65-79 years"	"65-79"	"Patient presented to hospital in full trauma alert after motorcycle crash on 9/8. Intubated with subarachnoid hemorrhage with base skull fracture and multiple other fractures. Covid test +. No improvement with multiple trauma appropriate treatments. Family agreed with comfort care on 9/13."
	"1700712-1"	"1700712-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient presented to hospital in full trauma alert after motorcycle crash on 9/8. Intubated with subarachnoid hemorrhage with base skull fracture and multiple other fractures. Covid test +. No improvement with multiple trauma appropriate treatments. Family agreed with comfort care on 9/13."
	"1700712-1"	"1700712-1"	"SKULL FRACTURED BASE"	"10040960"	"65-79 years"	"65-79"	"Patient presented to hospital in full trauma alert after motorcycle crash on 9/8. Intubated with subarachnoid hemorrhage with base skull fracture and multiple other fractures. Covid test +. No improvement with multiple trauma appropriate treatments. Family agreed with comfort care on 9/13."
	"1700712-1"	"1700712-1"	"SUBARACHNOID HAEMORRHAGE"	"10042316"	"65-79 years"	"65-79"	"Patient presented to hospital in full trauma alert after motorcycle crash on 9/8. Intubated with subarachnoid hemorrhage with base skull fracture and multiple other fractures. Covid test +. No improvement with multiple trauma appropriate treatments. Family agreed with comfort care on 9/13."
	"1700768-1"	"1700768-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Patient admitted on 08/26 diagnosed with COVID on 08/23. Presented to the hospital with sob, syncope and weakness.  DX with COVID PNA, hypoxia, syncope and Afib RVR. also with a PMHx of MS and on fingolimod. Patient continued to decompensate and expired on 09/10/12"
	"1700768-1"	"1700768-1"	"ATRIAL FIBRILLATION"	"10003658"	"65-79 years"	"65-79"	"Patient admitted on 08/26 diagnosed with COVID on 08/23. Presented to the hospital with sob, syncope and weakness.  DX with COVID PNA, hypoxia, syncope and Afib RVR. also with a PMHx of MS and on fingolimod. Patient continued to decompensate and expired on 09/10/12"
	"1700768-1"	"1700768-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient admitted on 08/26 diagnosed with COVID on 08/23. Presented to the hospital with sob, syncope and weakness.  DX with COVID PNA, hypoxia, syncope and Afib RVR. also with a PMHx of MS and on fingolimod. Patient continued to decompensate and expired on 09/10/12"
	"1700768-1"	"1700768-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Patient admitted on 08/26 diagnosed with COVID on 08/23. Presented to the hospital with sob, syncope and weakness.  DX with COVID PNA, hypoxia, syncope and Afib RVR. also with a PMHx of MS and on fingolimod. Patient continued to decompensate and expired on 09/10/12"
	"1700768-1"	"1700768-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient admitted on 08/26 diagnosed with COVID on 08/23. Presented to the hospital with sob, syncope and weakness.  DX with COVID PNA, hypoxia, syncope and Afib RVR. also with a PMHx of MS and on fingolimod. Patient continued to decompensate and expired on 09/10/12"
	"1700768-1"	"1700768-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient admitted on 08/26 diagnosed with COVID on 08/23. Presented to the hospital with sob, syncope and weakness.  DX with COVID PNA, hypoxia, syncope and Afib RVR. also with a PMHx of MS and on fingolimod. Patient continued to decompensate and expired on 09/10/12"
	"1700768-1"	"1700768-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Patient admitted on 08/26 diagnosed with COVID on 08/23. Presented to the hospital with sob, syncope and weakness.  DX with COVID PNA, hypoxia, syncope and Afib RVR. also with a PMHx of MS and on fingolimod. Patient continued to decompensate and expired on 09/10/12"
	"1700768-1"	"1700768-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Patient admitted on 08/26 diagnosed with COVID on 08/23. Presented to the hospital with sob, syncope and weakness.  DX with COVID PNA, hypoxia, syncope and Afib RVR. also with a PMHx of MS and on fingolimod. Patient continued to decompensate and expired on 09/10/12"
	"1700768-1"	"1700768-1"	"SYNCOPE"	"10042772"	"65-79 years"	"65-79"	"Patient admitted on 08/26 diagnosed with COVID on 08/23. Presented to the hospital with sob, syncope and weakness.  DX with COVID PNA, hypoxia, syncope and Afib RVR. also with a PMHx of MS and on fingolimod. Patient continued to decompensate and expired on 09/10/12"
	"1700861-1"	"1700861-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"Hospitalized and died. COVID-19 pneumonia. IV Remdesivir and Decadron; IV antibiotics, CCU, BiPap with setting of 16 over 10 with rate 12 and FiO2=80%; Severe sepsis; Acute kidney injury, cardiac arrest."
	"1700861-1"	"1700861-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Hospitalized and died. COVID-19 pneumonia. IV Remdesivir and Decadron; IV antibiotics, CCU, BiPap with setting of 16 over 10 with rate 12 and FiO2=80%; Severe sepsis; Acute kidney injury, cardiac arrest."
	"1700861-1"	"1700861-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"Hospitalized and died. COVID-19 pneumonia. IV Remdesivir and Decadron; IV antibiotics, CCU, BiPap with setting of 16 over 10 with rate 12 and FiO2=80%; Severe sepsis; Acute kidney injury, cardiac arrest."
	"1700861-1"	"1700861-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Hospitalized and died. COVID-19 pneumonia. IV Remdesivir and Decadron; IV antibiotics, CCU, BiPap with setting of 16 over 10 with rate 12 and FiO2=80%; Severe sepsis; Acute kidney injury, cardiac arrest."
	"1700861-1"	"1700861-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Hospitalized and died. COVID-19 pneumonia. IV Remdesivir and Decadron; IV antibiotics, CCU, BiPap with setting of 16 over 10 with rate 12 and FiO2=80%; Severe sepsis; Acute kidney injury, cardiac arrest."
	"1700861-1"	"1700861-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Hospitalized and died. COVID-19 pneumonia. IV Remdesivir and Decadron; IV antibiotics, CCU, BiPap with setting of 16 over 10 with rate 12 and FiO2=80%; Severe sepsis; Acute kidney injury, cardiac arrest."
	"1700861-1"	"1700861-1"	"PNEUMONIA"	"10035664"	"65-79 years"	"65-79"	"Hospitalized and died. COVID-19 pneumonia. IV Remdesivir and Decadron; IV antibiotics, CCU, BiPap with setting of 16 over 10 with rate 12 and FiO2=80%; Severe sepsis; Acute kidney injury, cardiac arrest."
	"1700861-1"	"1700861-1"	"POSITIVE AIRWAY PRESSURE THERAPY"	"10086397"	"65-79 years"	"65-79"	"Hospitalized and died. COVID-19 pneumonia. IV Remdesivir and Decadron; IV antibiotics, CCU, BiPap with setting of 16 over 10 with rate 12 and FiO2=80%; Severe sepsis; Acute kidney injury, cardiac arrest."
	"1700861-1"	"1700861-1"	"SEPSIS"	"10040047"	"65-79 years"	"65-79"	"Hospitalized and died. COVID-19 pneumonia. IV Remdesivir and Decadron; IV antibiotics, CCU, BiPap with setting of 16 over 10 with rate 12 and FiO2=80%; Severe sepsis; Acute kidney injury, cardiac arrest."
	"1700908-1"	"1700908-1"	"APHASIA"	"10002948"	"65-79 years"	"65-79"	"Sudden inability to walk, Hospice was called in, they determined probably only had months to live.  Stopped speaking and eating April 25, 2021, and passed away on May 1, 2021."
	"1700908-1"	"1700908-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Sudden inability to walk, Hospice was called in, they determined probably only had months to live.  Stopped speaking and eating April 25, 2021, and passed away on May 1, 2021."
	"1700908-1"	"1700908-1"	"DECREASED APPETITE"	"10061428"	"65-79 years"	"65-79"	"Sudden inability to walk, Hospice was called in, they determined probably only had months to live.  Stopped speaking and eating April 25, 2021, and passed away on May 1, 2021."
	"1700908-1"	"1700908-1"	"GAIT INABILITY"	"10017581"	"65-79 years"	"65-79"	"Sudden inability to walk, Hospice was called in, they determined probably only had months to live.  Stopped speaking and eating April 25, 2021, and passed away on May 1, 2021."
	"1704039-1"	"1704039-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"COVID RELATED DEATH; FULLY VACCINATED"
	"1704039-1"	"1704039-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"COVID RELATED DEATH; FULLY VACCINATED"
	"1704111-1"	"1704111-1"	"ABDOMINAL DISTENSION"	"10000060"	"65-79 years"	"65-79"	"Patient had known recent covid infection on 8/20/21. Admitted to hospital on 9/7/21 with SOB, abdominal distension and nausea, vomiting and diarrhea. Paracentesis was performed on 9/8 and 9/13 for continued abdominal swelling. Increasing need for 02 supplement due to swelling/volume overload. Chest xray worsening. Was being treated with combivent nebs and symibcort for COPD exacerbation and zosyn. Continued to decline with multiorgan compromise. Elected transition to comfort care and passed on 9/15."
	"1704111-1"	"1704111-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"Patient had known recent covid infection on 8/20/21. Admitted to hospital on 9/7/21 with SOB, abdominal distension and nausea, vomiting and diarrhea. Paracentesis was performed on 9/8 and 9/13 for continued abdominal swelling. Increasing need for 02 supplement due to swelling/volume overload. Chest xray worsening. Was being treated with combivent nebs and symibcort for COPD exacerbation and zosyn. Continued to decline with multiorgan compromise. Elected transition to comfort care and passed on 9/15."
	"1704111-1"	"1704111-1"	"CHRONIC OBSTRUCTIVE PULMONARY DISEASE"	"10009033"	"65-79 years"	"65-79"	"Patient had known recent covid infection on 8/20/21. Admitted to hospital on 9/7/21 with SOB, abdominal distension and nausea, vomiting and diarrhea. Paracentesis was performed on 9/8 and 9/13 for continued abdominal swelling. Increasing need for 02 supplement due to swelling/volume overload. Chest xray worsening. Was being treated with combivent nebs and symibcort for COPD exacerbation and zosyn. Continued to decline with multiorgan compromise. Elected transition to comfort care and passed on 9/15."
	"1704111-1"	"1704111-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Patient had known recent covid infection on 8/20/21. Admitted to hospital on 9/7/21 with SOB, abdominal distension and nausea, vomiting and diarrhea. Paracentesis was performed on 9/8 and 9/13 for continued abdominal swelling. Increasing need for 02 supplement due to swelling/volume overload. Chest xray worsening. Was being treated with combivent nebs and symibcort for COPD exacerbation and zosyn. Continued to decline with multiorgan compromise. Elected transition to comfort care and passed on 9/15."
	"1704111-1"	"1704111-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient had known recent covid infection on 8/20/21. Admitted to hospital on 9/7/21 with SOB, abdominal distension and nausea, vomiting and diarrhea. Paracentesis was performed on 9/8 and 9/13 for continued abdominal swelling. Increasing need for 02 supplement due to swelling/volume overload. Chest xray worsening. Was being treated with combivent nebs and symibcort for COPD exacerbation and zosyn. Continued to decline with multiorgan compromise. Elected transition to comfort care and passed on 9/15."
	"1704111-1"	"1704111-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient had known recent covid infection on 8/20/21. Admitted to hospital on 9/7/21 with SOB, abdominal distension and nausea, vomiting and diarrhea. Paracentesis was performed on 9/8 and 9/13 for continued abdominal swelling. Increasing need for 02 supplement due to swelling/volume overload. Chest xray worsening. Was being treated with combivent nebs and symibcort for COPD exacerbation and zosyn. Continued to decline with multiorgan compromise. Elected transition to comfort care and passed on 9/15."
	"1704111-1"	"1704111-1"	"DIARRHOEA"	"10012735"	"65-79 years"	"65-79"	"Patient had known recent covid infection on 8/20/21. Admitted to hospital on 9/7/21 with SOB, abdominal distension and nausea, vomiting and diarrhea. Paracentesis was performed on 9/8 and 9/13 for continued abdominal swelling. Increasing need for 02 supplement due to swelling/volume overload. Chest xray worsening. Was being treated with combivent nebs and symibcort for COPD exacerbation and zosyn. Continued to decline with multiorgan compromise. Elected transition to comfort care and passed on 9/15."
	"1704111-1"	"1704111-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Patient had known recent covid infection on 8/20/21. Admitted to hospital on 9/7/21 with SOB, abdominal distension and nausea, vomiting and diarrhea. Paracentesis was performed on 9/8 and 9/13 for continued abdominal swelling. Increasing need for 02 supplement due to swelling/volume overload. Chest xray worsening. Was being treated with combivent nebs and symibcort for COPD exacerbation and zosyn. Continued to decline with multiorgan compromise. Elected transition to comfort care and passed on 9/15."
	"1704111-1"	"1704111-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"Patient had known recent covid infection on 8/20/21. Admitted to hospital on 9/7/21 with SOB, abdominal distension and nausea, vomiting and diarrhea. Paracentesis was performed on 9/8 and 9/13 for continued abdominal swelling. Increasing need for 02 supplement due to swelling/volume overload. Chest xray worsening. Was being treated with combivent nebs and symibcort for COPD exacerbation and zosyn. Continued to decline with multiorgan compromise. Elected transition to comfort care and passed on 9/15."
	"1704111-1"	"1704111-1"	"HYPERVOLAEMIA"	"10020919"	"65-79 years"	"65-79"	"Patient had known recent covid infection on 8/20/21. Admitted to hospital on 9/7/21 with SOB, abdominal distension and nausea, vomiting and diarrhea. Paracentesis was performed on 9/8 and 9/13 for continued abdominal swelling. Increasing need for 02 supplement due to swelling/volume overload. Chest xray worsening. Was being treated with combivent nebs and symibcort for COPD exacerbation and zosyn. Continued to decline with multiorgan compromise. Elected transition to comfort care and passed on 9/15."
	"1704111-1"	"1704111-1"	"MULTIPLE ORGAN DYSFUNCTION SYNDROME"	"10077361"	"65-79 years"	"65-79"	"Patient had known recent covid infection on 8/20/21. Admitted to hospital on 9/7/21 with SOB, abdominal distension and nausea, vomiting and diarrhea. Paracentesis was performed on 9/8 and 9/13 for continued abdominal swelling. Increasing need for 02 supplement due to swelling/volume overload. Chest xray worsening. Was being treated with combivent nebs and symibcort for COPD exacerbation and zosyn. Continued to decline with multiorgan compromise. Elected transition to comfort care and passed on 9/15."
	"1704111-1"	"1704111-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"Patient had known recent covid infection on 8/20/21. Admitted to hospital on 9/7/21 with SOB, abdominal distension and nausea, vomiting and diarrhea. Paracentesis was performed on 9/8 and 9/13 for continued abdominal swelling. Increasing need for 02 supplement due to swelling/volume overload. Chest xray worsening. Was being treated with combivent nebs and symibcort for COPD exacerbation and zosyn. Continued to decline with multiorgan compromise. Elected transition to comfort care and passed on 9/15."
	"1704111-1"	"1704111-1"	"PARACENTESIS"	"10061905"	"65-79 years"	"65-79"	"Patient had known recent covid infection on 8/20/21. Admitted to hospital on 9/7/21 with SOB, abdominal distension and nausea, vomiting and diarrhea. Paracentesis was performed on 9/8 and 9/13 for continued abdominal swelling. Increasing need for 02 supplement due to swelling/volume overload. Chest xray worsening. Was being treated with combivent nebs and symibcort for COPD exacerbation and zosyn. Continued to decline with multiorgan compromise. Elected transition to comfort care and passed on 9/15."
	"1704111-1"	"1704111-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"Patient had known recent covid infection on 8/20/21. Admitted to hospital on 9/7/21 with SOB, abdominal distension and nausea, vomiting and diarrhea. Paracentesis was performed on 9/8 and 9/13 for continued abdominal swelling. Increasing need for 02 supplement due to swelling/volume overload. Chest xray worsening. Was being treated with combivent nebs and symibcort for COPD exacerbation and zosyn. Continued to decline with multiorgan compromise. Elected transition to comfort care and passed on 9/15."
	"1720055-1"	"1720055-1"	"ABDOMINAL DISCOMFORT"	"10000059"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"ATELECTASIS"	"10003598"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"BACK PAIN"	"10003988"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"CORONARY ARTERY DISEASE"	"10011078"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"DECREASED APPETITE"	"10061428"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"DIZZINESS"	"10013573"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"LUNG INFILTRATION"	"10025102"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"MYOCARDIAL INFARCTION"	"10028596"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"TROPONIN T INCREASED"	"10058269"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1720055-1"	"1720055-1"	"WEIGHT DECREASED"	"10047895"	"65-79 years"	"65-79"	"1st Moderna Covid imm given 3/15 or 3/19, within weeks afterward reported heartburn, early satiety, bloating. 2nd Moderna Covid imm given 4/16, within few wks afterward c/o gurgling stomach, decreased appetite, losing weight, nausea, back pain, loss of energy. Episode in May where he became lightheaded after working around home which was new. Easily fatigued. Had sudden cardiac arrest while sitting at home June 7 witnessed by wife, unresponsive, CPR initiated, taken to hospital, deceased June 10th cause of death myocardial infarction, coronary artery disease per wife"
	"1722958-1"	"1722958-1"	"BLOOD GLUCOSE DECREASED"	"10005555"	"65-79 years"	"65-79"	"Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021"
	"1722958-1"	"1722958-1"	"CHEST X-RAY"	"10008498"	"65-79 years"	"65-79"	"Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021"
	"1722958-1"	"1722958-1"	"COMPUTERISED TOMOGRAM THORAX"	"10053875"	"65-79 years"	"65-79"	"Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021"
	"1722958-1"	"1722958-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021"
	"1722958-1"	"1722958-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021"
	"1722958-1"	"1722958-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021"
	"1722958-1"	"1722958-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021"
	"1722958-1"	"1722958-1"	"FULL BLOOD COUNT"	"10017411"	"65-79 years"	"65-79"	"Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021"
	"1722958-1"	"1722958-1"	"METABOLIC FUNCTION TEST"	"10062191"	"65-79 years"	"65-79"	"Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021"
	"1722958-1"	"1722958-1"	"MUSCULAR WEAKNESS"	"10028372"	"65-79 years"	"65-79"	"Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021"
	"1722958-1"	"1722958-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021"
	"1722958-1"	"1722958-1"	"PHYSICAL DECONDITIONING"	"10051588"	"65-79 years"	"65-79"	"Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021"
	"1722958-1"	"1722958-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021"
	"1722958-1"	"1722958-1"	"SPINAL X-RAY"	"10041604"	"65-79 years"	"65-79"	"Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021"
	"1722958-1"	"1722958-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021"
	"1722958-1"	"1722958-1"	"WEIGHT DECREASED"	"10047895"	"65-79 years"	"65-79"	"Began 8/5/2021 non-productive cough, nausea, vomiting, 8 lbs. weight loss in last 2 months, dyspnea, deconditioning, lower extremity weakness COVID Quad collected 8/9/2021 that was positive for COVID-19. She expired 8/17/2021"
	"1723124-1"	"1723124-1"	"CHEST TUBE INSERTION"	"10050522"	"65-79 years"	"65-79"	"Death"
	"1723124-1"	"1723124-1"	"CHEST X-RAY"	"10008498"	"65-79 years"	"65-79"	"Death"
	"1723124-1"	"1723124-1"	"COMPUTERISED TOMOGRAM"	"10010234"	"65-79 years"	"65-79"	"Death"
	"1723124-1"	"1723124-1"	"COMPUTERISED TOMOGRAM THORAX"	"10053875"	"65-79 years"	"65-79"	"Death"
	"1723124-1"	"1723124-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death"
	"1723124-1"	"1723124-1"	"ECHOCARDIOGRAM"	"10014113"	"65-79 years"	"65-79"	"Death"
	"1723124-1"	"1723124-1"	"ULTRASOUND SCAN"	"10045434"	"65-79 years"	"65-79"	"Death"
	"1723877-1"	"1723877-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death-emts tried to ressusitate"
	"1723877-1"	"1723877-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Death-emts tried to ressusitate"
	"1731435-1"	"1731435-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer. Tested positive for COVID 19 @ 9/15/2021. Admitted on 9/15/2021 and expired on 9/20/2021 while still hospitalized."
	"1731435-1"	"1731435-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer. Tested positive for COVID 19 @ 9/15/2021. Admitted on 9/15/2021 and expired on 9/20/2021 while still hospitalized."
	"1731435-1"	"1731435-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer. Tested positive for COVID 19 @ 9/15/2021. Admitted on 9/15/2021 and expired on 9/20/2021 while still hospitalized."
	"1741639-1"	"1741639-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer vaccine. Last dose on 3/2/2021. Case tested positive for COVID on 9/7/21. Was admitted to hospital on 9/21/2021 and expired on 9/24/2021 while still hospitalized."
	"1741639-1"	"1741639-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer vaccine. Last dose on 3/2/2021. Case tested positive for COVID on 9/7/21. Was admitted to hospital on 9/21/2021 and expired on 9/24/2021 while still hospitalized."
	"1741639-1"	"1741639-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer vaccine. Last dose on 3/2/2021. Case tested positive for COVID on 9/7/21. Was admitted to hospital on 9/21/2021 and expired on 9/24/2021 while still hospitalized."
	"1741688-1"	"1741688-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer Vaccine. Last dose given on 1/22/2021. Tested positive for COVID on 9/21/2021. Case expired at Hospital East while in the ED on 9/26/2021."
	"1741688-1"	"1741688-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer Vaccine. Last dose given on 1/22/2021. Tested positive for COVID on 9/21/2021. Case expired at Hospital East while in the ED on 9/26/2021."
	"1741688-1"	"1741688-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer Vaccine. Last dose given on 1/22/2021. Tested positive for COVID on 9/21/2021. Case expired at Hospital East while in the ED on 9/26/2021."
	"1749522-1"	"1749522-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"PT EXPIRED; BREAKTHROUGH CASE OF COVID-19"
	"1749522-1"	"1749522-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"PT EXPIRED; BREAKTHROUGH CASE OF COVID-19"
	"1749522-1"	"1749522-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"PT EXPIRED; BREAKTHROUGH CASE OF COVID-19"
	"1758695-1"	"1758695-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"PATIENT TESTED POSITIVE FOR COVID-19 ON 10/1/2021 (BREAKTHROUGH CASE); PATIENT EXPIRED ON 10/3/2021"
	"1758695-1"	"1758695-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"PATIENT TESTED POSITIVE FOR COVID-19 ON 10/1/2021 (BREAKTHROUGH CASE); PATIENT EXPIRED ON 10/3/2021"
	"1758695-1"	"1758695-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"PATIENT TESTED POSITIVE FOR COVID-19 ON 10/1/2021 (BREAKTHROUGH CASE); PATIENT EXPIRED ON 10/3/2021"
	"1758695-1"	"1758695-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"PATIENT TESTED POSITIVE FOR COVID-19 ON 10/1/2021 (BREAKTHROUGH CASE); PATIENT EXPIRED ON 10/3/2021"
	"1758810-1"	"1758810-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"PATIENT TESTED POSITIVE FOR COVID-19 ON 8/27/2021; EXPIRED ON 10/3/2021"
	"1758810-1"	"1758810-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"PATIENT TESTED POSITIVE FOR COVID-19 ON 8/27/2021; EXPIRED ON 10/3/2021"
	"1758810-1"	"1758810-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"PATIENT TESTED POSITIVE FOR COVID-19 ON 8/27/2021; EXPIRED ON 10/3/2021"
	"1759243-1"	"1759243-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"ADENOVIRUS TEST"	"10050991"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"AORTIC VALVE INCOMPETENCE"	"10002915"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"ATELECTASIS"	"10003598"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"ATRIAL FIBRILLATION"	"10003658"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"BLOOD CULTURE NEGATIVE"	"10005486"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"BORDETELLA TEST NEGATIVE"	"10070278"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"CARDIAC FAILURE ACUTE"	"10007556"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"CARDIAC FAILURE CONGESTIVE"	"10007559"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"CARDIOMEGALY"	"10007632"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"CENTRAL VENOUS CATHETERISATION"	"10053377"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"CHEST TUBE INSERTION"	"10050522"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"CHLAMYDIA TEST NEGATIVE"	"10070273"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"CHRONIC OBSTRUCTIVE PULMONARY DISEASE"	"10009033"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"CLOSTRIDIUM TEST NEGATIVE"	"10070271"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"COAGULOPATHY"	"10009802"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"COMPUTERISED TOMOGRAM ABDOMEN"	"10053876"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"CORONAVIRUS TEST NEGATIVE"	"10084269"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"CULTURE"	"10061447"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"ECHOCARDIOGRAM ABNORMAL"	"10061593"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"ENTEROVIRUS TEST NEGATIVE"	"10070397"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"FUNGAL TEST"	"10070457"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"GENERAL PHYSICAL HEALTH DETERIORATION"	"10049438"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"HIATUS HERNIA"	"10020028"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"HUMAN METAPNEUMOVIRUS TEST"	"10072858"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"HUMAN RHINOVIRUS TEST"	"10075163"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"ILLNESS"	"10080284"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"INFLUENZA A VIRUS TEST NEGATIVE"	"10070417"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"INFLUENZA B VIRUS TEST"	"10071544"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"INFLUENZA VIRUS TEST NEGATIVE"	"10070718"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"LACTIC ACIDOSIS"	"10023676"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"LEFT VENTRICULAR FAILURE"	"10024119"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"LIVER FUNCTION TEST INCREASED"	"10077692"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"LUNG INFILTRATION"	"10025102"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"LUNG OPACITY"	"10081792"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"MALNUTRITION"	"10061273"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"MYCOBACTERIUM TEST NEGATIVE"	"10070408"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"MYCOPLASMA TEST NEGATIVE"	"10078590"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"NEPHROLITHIASIS"	"10029148"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"PLEURAL EFFUSION"	"10035598"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"PNEUMONIA BACTERIAL"	"10060946"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"PNEUMOTHORAX"	"10035759"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"PULMONARY HYPERTENSION"	"10037400"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"PULMONARY OEDEMA"	"10037423"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"RENAL FAILURE"	"10038435"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"RESPIRATORY SYNCYTIAL VIRUS TEST NEGATIVE"	"10068564"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"RESPIRATORY TRACT CONGESTION"	"10052251"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"RESPIRATORY VIRAL PANEL"	"10075165"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"SEPTIC SHOCK"	"10040070"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"SOMNOLENCE"	"10041349"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"ULTRASOUND CHEST"	"10052962"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"ULTRASOUND DOPPLER ABNORMAL"	"10045413"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"ULTRASOUND LIVER ABNORMAL"	"10045428"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"URINE OUTPUT DECREASED"	"10059895"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"VIRAL TEST NEGATIVE"	"10062362"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759243-1"	"1759243-1"	"X-RAY"	"10048064"	"65-79 years"	"65-79"	"ED to Hosp-Admission  Discharged 8/27/2021 - 9/15/2021 (19 days) Last attending ? Treatment team Acute on chronic diastolic (congestive) heart failure Final Summary for Deceased Patient   BRIEF OVERVIEW Admitting Provider: MD Discharge Provider: MD Primary Care Physician at Discharge: MD    Admission Date: 8/27/2021     Discharge Date: 9/15/2021   Final Diagnosis Principal Problem:   Acute on chronic diastolic (congestive) heart failure  Active Problems:   Paroxysmal A-fib   Pulmonary hypertension, moderate to severe   Chronic obstructive pulmonary disease with acute exacerbation   Pleural effusion on right   End stage COPD   Congestive heart failure, unspecified HF chronicity, unspecified heart failure type   Endocarditis   Lactic acidosis     DETAILS OF HOSPITAL STAY   Date and time of death: September 15, 2021, 12:11 PM   Cause of death: Septic shock from COVID-19 pneumonia Acute respiratory failure from COVID-19 and systolic heart failure   Secondary diagnoses: Severe aortic insufficiency Superimposed bacterial pneumonia Acute renal failure Lactic acidosis Possible endocarditis Atrial fibrillation with rapid ventricular response End-stage COPD Elevated LFTs Coagulopathy from malnutrition and acute illness   Hospital Course Patient is a 72-year-old female with history of COPD, atrial fibrillation on Coumadin, systolic heart failure, recent TMVR presented to the hospital with systolic heart failure.  She is admitted to medical service and seen by the heart failure team.  Echocardiogram showed severe aortic insufficiency and was being considered for valve intervention.  She was treated with IV diuretics however her respiratory status did not improve.  Hospital course was prolonged and she was hospitalized for 18 days.  There is consideration of endocarditis given possible vegetations noted on aortic valve.  CT surgery recommended aggressive antibiotic regimen and stated she was high risk for surgery.  Initially was plan for IV antibiotics through October 4.  She was treated with Lasix infusion, however urine output became marginal.  Patient's x-ray developed progressive infiltrates and on September 14 she was found to have COVID-19 infection.  She was started on steroids and received plasma as well.  Antibiotics were also broadened to cover potential superimposed bacterial pneumonia.  Despite this, her clinical condition deteriorated.  She developed progressive renal failure as well as elevated LFTs and coagulopathy.  She became more somnolent and oxygen requirement escalated.  She became progressively critically ill and was requiring vasopressors, and was maxed on norepinephrine.  Unfortunately, she continued to deteriorate and passed away on September 15.  I passed along my condolences to the patient's son."
	"1759327-1"	"1759327-1"	"ACQUIRED DIAPHRAGMATIC EVENTRATION"	"10059185"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"ADENOVIRUS TEST"	"10050991"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"ANGIOGRAM PULMONARY"	"10002440"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"ANTICOAGULANT THERAPY"	"10053468"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"ANTICOAGULATION DRUG LEVEL ABOVE THERAPEUTIC"	"10060320"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"ANXIETY"	"10002855"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"ARTERIOSCLEROSIS CORONARY ARTERY"	"10003211"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"BLADDER DISORDER"	"10061011"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"BORDETELLA TEST NEGATIVE"	"10070278"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"BREATH SOUNDS ABNORMAL"	"10064780"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"CHLAMYDIA TEST NEGATIVE"	"10070273"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"COMPUTERISED TOMOGRAM ABDOMEN ABNORMAL"	"10057798"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"COMPUTERISED TOMOGRAM THORAX ABNORMAL"	"10057799"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"CORONAVIRUS TEST NEGATIVE"	"10084269"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"ENCEPHALOPATHY"	"10014625"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"ENTEROVIRUS TEST NEGATIVE"	"10070397"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"HIATUS HERNIA"	"10020028"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"HIP FRACTURE"	"10020100"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"HUMAN METAPNEUMOVIRUS TEST"	"10072858"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"HUMAN RHINOVIRUS TEST"	"10075163"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"HYPOTHERMIA"	"10021113"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"IMMUNODEFICIENCY"	"10061598"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"INFLUENZA A VIRUS TEST NEGATIVE"	"10070417"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"INFLUENZA B VIRUS TEST"	"10071544"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"INFLUENZA VIRUS TEST NEGATIVE"	"10070718"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"INTERNATIONAL NORMALISED RATIO INCREASED"	"10022595"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"LUNG INFILTRATION"	"10025102"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"LUNG OPACITY"	"10081792"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"MULTIMORBIDITY"	"10063914"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"MYCOPLASMA TEST NEGATIVE"	"10078590"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"OPEN REDUCTION OF FRACTURE"	"10030682"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"PNEUMOBILIA"	"10066004"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"PNEUMONIA VIRAL"	"10035737"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"RENAL CYST"	"10038423"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"RESPIRATORY SYNCYTIAL VIRUS TEST NEGATIVE"	"10068564"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"RESPIRATORY VIRAL PANEL"	"10075165"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"RESTLESSNESS"	"10038743"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"RHEUMATOID ARTHRITIS"	"10039073"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"SCAN WITH CONTRAST ABNORMAL"	"10062152"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"UTERINE LEIOMYOMA"	"10046798"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759327-1"	"1759327-1"	"VENA CAVA FILTER INSERTION"	"10048932"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged  9/13/2021 - 9/18/2021 (5 days)         Hospital Problems       * (Principal) COVID-19 Yes         Rheumatoid arthritis  Yes        RHEUMATOID ARTHRITIS;             Current use of long term anticoagulation Not Applicable         Supratherapeutic INR Yes         Acute hypoxemic respiratory failure Yes         Encephalopathy Yes         Poor prognosis Yes         Immunosuppressed status Yes  Presenting Problem/History of Present Illness/Reason for Admission Acute hypoxemic respiratory failure     Hospital Course 1.  Acute hypoxic respiratory failure secondary to COVID-19 pneumonia: Patient has been continued on remdesivir IV, Decadron 6 mg IV, infectious disease consultation appreciated patient is not a candidate for baricitinib as she has immunosuppression. 2.  Supratherapeutic INR: Patient got a dose of vitamin K  3.  Known rheumatoid arthritis on multiple immunosuppressive medications including prednisone methotrexate and rinvoq , hold on medications until she recovers from COVID-19 pneumonia.  4. Hypothermia likely related to severe infection with COVID: resolved    Because of the comorbidities, patient was extremely sick and was requiring very high oxygen she decided to change her CODE STATUS to comfort care, patient will be changed to hospice.   Operative Procedures Performed   Treatments: treated  for Covid, changed to comfort care Procedures: none Consults: none Pertinent Test Results:none Physical Exam at Discharge Heart Rate: (!) 104 Resp: (!) 24 BP: 119/84 Temperature: 36.6 ¦C (97.8 ¦F) Weight: 71.9 kg (158 lb 8.2 oz) General: Patient seems very sick, seems anxious HEENT: Atraumatic normocephalic Neck supple CVs: S1-S2 regular rate and rhythm Respiratory: Patient has bilateral coarse breath sounds, requiring supplemental oxygen with  nasal cannula Abdomen: Soft nontender bowel sounds present Neurologically: seems restless Patient has right BKA   Discharge Instructions Condition at Discharge Discharge Condition: very sick   Chief Complaint Patient presents with ? Shortness of Breath     1. Acute hypoxemic respiratory failure 2. COVID-19 3. Current use of long-term anticoagulation 4. Supratherapeutic INR 5. Poor prognosis 6. Encephalopathy   Plan:     Pulse oximetry continuously - high flow nasal cannula. Consult pulmonology.    Decadron 6mg IV daily   Remdesevir IV full course   guidelines advise AGAINST routine plasma use in hospitalized patients. I do not believe benefits > risks.    Spoke to ED physician personally   Given vitamin K to reverse INR > 9.8   Critical care time spent 60 minutes     o Nutrition: heart healthy if passes dysphagia screen o VTE prophylaxis: heparin o Full Code           History of Present Illness   a 69 y.o. female.       I personally interviewed patient, reviewed chart, and reviewed emergency room resident history and agree with it in its following entirety unless otherwise noted below.  "" a 69 y.o. female w h/o DVT on coumadin, vaccinated against covid. presenting to the ED with weakness and fatigue for the past 2 weeks.  Patient is not able to provide much history.  Per her sister she has been ill for the past 2 weeks symptoms including weakness, fatigue, shortness of breath.  She is normally alert and oriented x3, no history of dementia.  She was seen in urgent care and prescribed antibiotics and steroids but she did not receive a Covid test.  She continued to worsen on the next couple days and her neighbors who checked on her, and she was not very responsive so they called EMS.  Per EMS patient was satting approximately 50% on room air and she was put on nonrebreather at 15 L and had improvement in saturation.""   Patient is on high flow nasal cannula saturating in the upper 90s.  She has a very poor historian.   Not coughing just short of breath.   No edema   No rashes       Principal problem Acute hypoxic respiratory failure Covid pneumonia Rheumatoid arthritis-immunocompromised state     Patient was admitted to Hospital on 9/13 with Covid pneumonia and acute hypoxic respiratory failure.  She was requiring high flow nasal cannula at the time of admission.  She was started on Decadron and IV remdesivir. Due to the requirement of high flow nasal cannula pulmonology was consulted and also infectious disease was also consulted. Per infectious disease immunomodulators are contraindicated in this immunosuppressed patient.   Due to patient worsening respiratory state patient opted for comfort care and hospice.   Patient was changed to comfort care and was consulted on 9/17.   Patient is continued on comfort care medications with the help of the hospice   Patient died on 9/21 at 2320""
	"1759487-1"	"1759487-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"ADENOVIRUS TEST"	"10050991"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"ANAEMIA"	"10002034"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"BLOOD LOSS ANAEMIA"	"10082297"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"BORDETELLA TEST NEGATIVE"	"10070278"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"CARDIAC FAILURE CONGESTIVE"	"10007559"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"CARDIOGENIC SHOCK"	"10007625"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"CARDIOMEGALY"	"10007632"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"CHILLS"	"10008531"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"CHLAMYDIA TEST NEGATIVE"	"10070273"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"CHRONIC KIDNEY DISEASE"	"10064848"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"CORONAVIRUS TEST NEGATIVE"	"10084269"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"EJECTION FRACTION DECREASED"	"10050528"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"ENTEROVIRUS TEST NEGATIVE"	"10070397"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"FIBRIN D DIMER INCREASED"	"10016581"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"GOITRE"	"10018498"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"HUMAN METAPNEUMOVIRUS TEST"	"10072858"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"HUMAN RHINOVIRUS TEST"	"10075163"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"IMMUNODEFICIENCY"	"10061598"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"INFLUENZA A VIRUS TEST NEGATIVE"	"10070417"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"INFLUENZA B VIRUS TEST"	"10071544"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"INFLUENZA VIRUS TEST NEGATIVE"	"10070718"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"LUNG INFILTRATION"	"10025102"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"LUNG OPACITY"	"10081792"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"MACROCEPHALY"	"10050183"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"MULTIPLE ORGAN DYSFUNCTION SYNDROME"	"10077361"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"MYCOPLASMA TEST NEGATIVE"	"10078590"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"OEDEMA PERIPHERAL"	"10030124"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"RENAL CYST"	"10038423"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"RESPIRATORY SYNCYTIAL VIRUS TEST NEGATIVE"	"10068564"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"SEPSIS"	"10040047"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"SEPTIC SHOCK"	"10040070"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"TRANSAMINASES INCREASED"	"10054889"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"TRANSFUSION"	"10066152"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"TYPE 2 DIABETES MELLITUS"	"10067585"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"ULTRASOUND DOPPLER NORMAL"	"10045414"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"ULTRASOUND KIDNEY ABNORMAL"	"10045422"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"ULTRASOUND SCAN NORMAL"	"10061607"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"VASODILATATION"	"10047141"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1759487-1"	"1759487-1"	"VENTILATION/PERFUSION SCAN"	"10047264"	"65-79 years"	"65-79"	""ED to Hosp-Admission  Discharged 9/15/2021 - 9/18/2021 (3 days).   Last attending ? Treatment team Anemia requiring transfusions  Principal problem   Details of Hospital Stay     Presenting Problem/History of Present Illness/Reason for Admission Chills [R68.83] Weakness [R53.1] Anemia requiring transfusions [D64.9] Acute kidney injury superimposed on CKD (HCC) [N17.9, N18.9]     Hospital Course 1.  Severe sepsis secondary to Covid pneumonia in a immunocompromise patient, patient also has endorgan damage which includes acute renal failure and transaminitis.  Patient has been started on cefepime and doxycycline, Decadron.  Time of discharge I have changed him to cefpodoxime and doxycycline for 2 more days, he will be on dexamethasone 6 mg oral for 5 more days Was  not a candidate for convalescent plasma and remdesivir due to transaminits 2.  Elevated D-dimer: VQ scan negative for pulmonary embolism, ultrasound lower extremity negative for DVT 3.  Acute blood loss anemia related to MDS: Status post blood transfusion, outpatient follow-up with oncology as outpatient. 4.Acute  Renal failure superimposed on CKD stage III: Nephrology has been consulted, holding on Entresto. At the time  of discharge his renal function has improved, needs follow-up as outpatient with his family doctor 5.  Systolic heart failure ejection fraction 30%: Holding on entresto, he could have as needed Lasix 20 mg for shortness of breath, follow-up with heart failure clinic as outpatient 6.  Atrial fibrillation: Continued on home medication 7 coronary artery disease with CABG 2009, peripheral arterial disease with carotid stenting, AAA with endovascular repair: Not on aspirin due to MDS 8.  Diabetes mellitus 2: On glipizide 9.  Hypothyroidism: Continue Synthyroid Physical Exam at Discharge Heart Rate: (!) 55 Resp: 18 BP: 123/57 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.8 kg (213 lb 6.5 oz)   Physical Exam General : Patient is no acute distress, sitting comfortably HEENT: Atraumatic normocephalic Neck supple CVS: S1-S2 regular rate and rhythm Respiratory: Bilateral equal entry, no wheezing sounds heard Abdomen: Soft nontender bowel sounds present Neurologically: Alert and oriented x3, moving all extremities Extremities no edema ED to Hosp-Admission Discharged   9/20/2021 - 9/27/2021 (7 days)    Last attending ? Treatment team COVID-19  Principal problem    Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic systolic (congestive) heart failure (HCC) [I50.23] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type (HCC) [I50.9] 2019 novel coronavirus disease (COVID-19) [U07.1] Atrial fibrillation with rapid ventricular response (HCC) [I48.91] Diabetes type 2 Severe sepsis due to COVID-19 Cardiogenic versus septic shock Acute renal failure with ATN   Hospital Course Patient was recently hospitalized for Covid infection.  He tested positive on 9/15/2021.  He was discharged on 9/18.  He returned to the emergency department on 9/20/2021 with increased shortness of breath and weakness.  He does have underlying immunocompromised state in the setting of myelodysplastic syndrome, receiving weekly infusions.  He was receiving aggressive care on the medical floor for Covid with steroids and antibiotics, when he decompensated on 9/24/2021.  He was transferred to the ICU.  He was in atrial fibrillation with RVR with a heart rate of 140, blood pressure was 60 over 30s.  He was presumed to be in cardiogenic versus septic shock.  He has multisystem organ failure including heart failure, respiratory failure, kidney failure, and transaminitis.  Initially he was full team.  After discussion with patient and his wife, he is now DNR with short-term intubation only.  He cannot receive remdesivir because of transaminitis.  He cannot receive interleukin-6 because of immunocompromised state.   His ICU course consisted of milrinone drip, Lasix infusion, amiodarone infusion, and brief requirement of norepinephrine.  He has acute renal failure, likely ATN.  He also has transaminitis, acute on chronic congestive heart failure, and worsening Covid pneumonia.  He continues to have hypoxic respiratory failure requiring high flow nasal cannula +100% nonrebreather.  He is essentially requiring a cumulative amount of 75 L of oxygen.   Today he was initially agitated when discussing hospice and states ""I will not talk to the death squad"". He is insistent on going home, but cannot navigate the decision making process. He does not understand why he can't go home (even though there is no one physically able to care for him at home).  In discussion with his wife, the decision was made to transition him to hospice.  He is uremic and hypoxemic, and likely cannot make high-level decisions.  The patient does agree to go on hospice service.  He was initially adamant about not receiving morphine.  Therefore, we will use hydromorphone infusion as well as scheduled lorazepam and PRN dosing given his significant anxiety.   He will be discharged, and readmitted under inpatient hospice.  It is not feasible at this time for him to go home unfortunately.   Operative Procedures Performed   Physical Exam at Discharge Heart Rate: 60 Resp: (!) 10 BP: (!) 148/59 Temperature: 36.5 ¦C (97.7 ¦F) Weight: 96.5 kg (212 lb 11.9 oz)   General: Elderly ill-appearing gentleman sitting upright, appears in mild distress Neck: neck veins are distended Cardiovascular: s1/2, rrr.  Warm extremities with positive pulses Respiratory: Lungs are coarse throughout GI/GU: Abdomen is soft and nontender with positive bowel sounds Musculoskeletal: Trace lower extremity edema Integumentary: Skin is pale warm and dry Neurologic: Patient is alert.  He is oriented to self, place and situation.   He moves all extremities equally. Sensation intact Psychiatric: agitated, blunted affect   Condition at Discharge Discharge Condition: poor""
	"1760463-1"	"1760463-1"	"BACK PAIN"	"10003988"	"65-79 years"	"65-79"	"Backache/side ache most of the day on Sept 25th. My mother thought it might be a kidney stone so she took Ibuprofen every 4 hours. She also had nausea most of the morning of the 25th. She woke up around 2am on the 26th gasping for air and could barely breathe. She went into cardiac arrest."
	"1760463-1"	"1760463-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Backache/side ache most of the day on Sept 25th. My mother thought it might be a kidney stone so she took Ibuprofen every 4 hours. She also had nausea most of the morning of the 25th. She woke up around 2am on the 26th gasping for air and could barely breathe. She went into cardiac arrest."
	"1760463-1"	"1760463-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Backache/side ache most of the day on Sept 25th. My mother thought it might be a kidney stone so she took Ibuprofen every 4 hours. She also had nausea most of the morning of the 25th. She woke up around 2am on the 26th gasping for air and could barely breathe. She went into cardiac arrest."
	"1760463-1"	"1760463-1"	"FLANK PAIN"	"10016750"	"65-79 years"	"65-79"	"Backache/side ache most of the day on Sept 25th. My mother thought it might be a kidney stone so she took Ibuprofen every 4 hours. She also had nausea most of the morning of the 25th. She woke up around 2am on the 26th gasping for air and could barely breathe. She went into cardiac arrest."
	"1760463-1"	"1760463-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"Backache/side ache most of the day on Sept 25th. My mother thought it might be a kidney stone so she took Ibuprofen every 4 hours. She also had nausea most of the morning of the 25th. She woke up around 2am on the 26th gasping for air and could barely breathe. She went into cardiac arrest."
	"1764194-1"	"1764194-1"	"CEREBROVASCULAR ACCIDENT"	"10008190"	"65-79 years"	"65-79"	"Swelling and bumps; Double stroke; This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (Double stroke) in a 79-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.    On 11-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Jul-2021, the patient experienced CEREBROVASCULAR ACCIDENT (Double stroke) (seriousness criteria death and medically significant). On an unknown date, the patient experienced SWELLING (Swelling and bumps). The patient died on 20-Jul-2021. The reported cause of death was double stroke. It is unknown if an autopsy was performed. At the time of death, SWELLING (Swelling and bumps) outcome was unknown.            Patient passed away after getting Moderna COVID-19 Vaccine. No relevant concomitant medications were reported. No treatment information was reported.; Sender's Comments: This case concerns a 75 year old male with no relevant medical history who experienced serious unexpected fatal event of CVA approximately 2 months after the first dose of the vaccine. Rechallenge was not applicable. The benefit-risk relationship is not affected by this report.; Reported Cause(s) of Death: Double Stroke"
	"1764194-1"	"1764194-1"	"SWELLING"	"10042674"	"65-79 years"	"65-79"	"Swelling and bumps; Double stroke; This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (Double stroke) in a 79-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below.     No Medical History information was reported.    On 11-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Jul-2021, the patient experienced CEREBROVASCULAR ACCIDENT (Double stroke) (seriousness criteria death and medically significant). On an unknown date, the patient experienced SWELLING (Swelling and bumps). The patient died on 20-Jul-2021. The reported cause of death was double stroke. It is unknown if an autopsy was performed. At the time of death, SWELLING (Swelling and bumps) outcome was unknown.            Patient passed away after getting Moderna COVID-19 Vaccine. No relevant concomitant medications were reported. No treatment information was reported.; Sender's Comments: This case concerns a 75 year old male with no relevant medical history who experienced serious unexpected fatal event of CVA approximately 2 months after the first dose of the vaccine. Rechallenge was not applicable. The benefit-risk relationship is not affected by this report.; Reported Cause(s) of Death: Double Stroke"
	"1765464-1"	"1765464-1"	"IMMEDIATE POST-INJECTION REACTION"	"10067142"	"65-79 years"	"65-79"	"Immediate rash and swelling in groin and upper extremities .  Swollen lymph nodes within two weeks.  Lymphoma diagnosis July"
	"1765464-1"	"1765464-1"	"LABORATORY TEST"	"10059938"	"65-79 years"	"65-79"	"Immediate rash and swelling in groin and upper extremities .  Swollen lymph nodes within two weeks.  Lymphoma diagnosis July"
	"1765464-1"	"1765464-1"	"LYMPHADENOPATHY"	"10025197"	"65-79 years"	"65-79"	"Immediate rash and swelling in groin and upper extremities .  Swollen lymph nodes within two weeks.  Lymphoma diagnosis July"
	"1765464-1"	"1765464-1"	"LYMPHOMA"	"10025310"	"65-79 years"	"65-79"	"Immediate rash and swelling in groin and upper extremities .  Swollen lymph nodes within two weeks.  Lymphoma diagnosis July"
	"1765464-1"	"1765464-1"	"PERIPHERAL SWELLING"	"10048959"	"65-79 years"	"65-79"	"Immediate rash and swelling in groin and upper extremities .  Swollen lymph nodes within two weeks.  Lymphoma diagnosis July"
	"1765464-1"	"1765464-1"	"RASH"	"10037844"	"65-79 years"	"65-79"	"Immediate rash and swelling in groin and upper extremities .  Swollen lymph nodes within two weeks.  Lymphoma diagnosis July"
	"1765464-1"	"1765464-1"	"SWELLING"	"10042674"	"65-79 years"	"65-79"	"Immediate rash and swelling in groin and upper extremities .  Swollen lymph nodes within two weeks.  Lymphoma diagnosis July"
	"1768207-1"	"1768207-1"	"ACUTE MYOCARDIAL INFARCTION"	"10000891"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"CARDIOVERSION"	"10007661"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"EJECTION FRACTION DECREASED"	"10050528"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"ELECTROCARDIOGRAM ST SEGMENT ELEVATION"	"10014392"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"HAEMOFILTRATION"	"10053090"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"HEPATIC FAILURE"	"10019663"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"PNEUMOTHORAX"	"10035759"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"PULSE ABSENT"	"10037469"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"RESPIRATORY FAILURE"	"10038695"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"SEIZURE LIKE PHENOMENA"	"10071048"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"SHOCK"	"10040560"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"VENTRICULAR TACHYCARDIA"	"10047302"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768207-1"	"1768207-1"	"VOMITING"	"10047700"	"65-79 years"	"65-79"	"Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with  SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach.  Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips.  STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care."
	"1768253-1"	"1768253-1"	"BRAIN COMPRESSION"	"10006112"	"65-79 years"	"65-79"	"Had tested covid + on 8/-22-25 at another facility. Admitted on 9/14 with large right cerebellar stroke, edema, compression and hydrocephalus. Has required multiple admissions to ICU for neuro status changes. Covid + on admission by PCR. Family requested no aggressive treatment. Ventriculostomy stopped draining and removed. Family requested comfort care only."
	"1768253-1"	"1768253-1"	"CEREBELLAR STROKE"	"10079062"	"65-79 years"	"65-79"	"Had tested covid + on 8/-22-25 at another facility. Admitted on 9/14 with large right cerebellar stroke, edema, compression and hydrocephalus. Has required multiple admissions to ICU for neuro status changes. Covid + on admission by PCR. Family requested no aggressive treatment. Ventriculostomy stopped draining and removed. Family requested comfort care only."
	"1768253-1"	"1768253-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Had tested covid + on 8/-22-25 at another facility. Admitted on 9/14 with large right cerebellar stroke, edema, compression and hydrocephalus. Has required multiple admissions to ICU for neuro status changes. Covid + on admission by PCR. Family requested no aggressive treatment. Ventriculostomy stopped draining and removed. Family requested comfort care only."
	"1768253-1"	"1768253-1"	"HYDROCEPHALUS"	"10020508"	"65-79 years"	"65-79"	"Had tested covid + on 8/-22-25 at another facility. Admitted on 9/14 with large right cerebellar stroke, edema, compression and hydrocephalus. Has required multiple admissions to ICU for neuro status changes. Covid + on admission by PCR. Family requested no aggressive treatment. Ventriculostomy stopped draining and removed. Family requested comfort care only."
	"1768253-1"	"1768253-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Had tested covid + on 8/-22-25 at another facility. Admitted on 9/14 with large right cerebellar stroke, edema, compression and hydrocephalus. Has required multiple admissions to ICU for neuro status changes. Covid + on admission by PCR. Family requested no aggressive treatment. Ventriculostomy stopped draining and removed. Family requested comfort care only."
	"1768253-1"	"1768253-1"	"MEDICAL DEVICE REMOVAL"	"10052971"	"65-79 years"	"65-79"	"Had tested covid + on 8/-22-25 at another facility. Admitted on 9/14 with large right cerebellar stroke, edema, compression and hydrocephalus. Has required multiple admissions to ICU for neuro status changes. Covid + on admission by PCR. Family requested no aggressive treatment. Ventriculostomy stopped draining and removed. Family requested comfort care only."
	"1768253-1"	"1768253-1"	"NEUROLOGICAL SYMPTOM"	"10060860"	"65-79 years"	"65-79"	"Had tested covid + on 8/-22-25 at another facility. Admitted on 9/14 with large right cerebellar stroke, edema, compression and hydrocephalus. Has required multiple admissions to ICU for neuro status changes. Covid + on admission by PCR. Family requested no aggressive treatment. Ventriculostomy stopped draining and removed. Family requested comfort care only."
	"1768253-1"	"1768253-1"	"OEDEMA"	"10030095"	"65-79 years"	"65-79"	"Had tested covid + on 8/-22-25 at another facility. Admitted on 9/14 with large right cerebellar stroke, edema, compression and hydrocephalus. Has required multiple admissions to ICU for neuro status changes. Covid + on admission by PCR. Family requested no aggressive treatment. Ventriculostomy stopped draining and removed. Family requested comfort care only."
	"1768253-1"	"1768253-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Had tested covid + on 8/-22-25 at another facility. Admitted on 9/14 with large right cerebellar stroke, edema, compression and hydrocephalus. Has required multiple admissions to ICU for neuro status changes. Covid + on admission by PCR. Family requested no aggressive treatment. Ventriculostomy stopped draining and removed. Family requested comfort care only."
	"1768253-1"	"1768253-1"	"THERAPY CESSATION"	"10065154"	"65-79 years"	"65-79"	"Had tested covid + on 8/-22-25 at another facility. Admitted on 9/14 with large right cerebellar stroke, edema, compression and hydrocephalus. Has required multiple admissions to ICU for neuro status changes. Covid + on admission by PCR. Family requested no aggressive treatment. Ventriculostomy stopped draining and removed. Family requested comfort care only."
	"1771519-1"	"1771519-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient expired due to COVID-19 after having been vaccinated."
	"1771519-1"	"1771519-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient expired due to COVID-19 after having been vaccinated."
	"1771519-1"	"1771519-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient expired due to COVID-19 after having been vaccinated."
	"1771542-1"	"1771542-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient expired due to COVID-19"
	"1771542-1"	"1771542-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient expired due to COVID-19"
	"1771542-1"	"1771542-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient expired due to COVID-19"
	"1772039-1"	"1772039-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Case vaccinated with Janssen on 5/28/2021. Tested positive for COVID on 9/16/2021. Admitted to Hospital on 9/21/2021 and expired on 10/02/2021 while still hospitalized."
	"1772039-1"	"1772039-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Case vaccinated with Janssen on 5/28/2021. Tested positive for COVID on 9/16/2021. Admitted to Hospital on 9/21/2021 and expired on 10/02/2021 while still hospitalized."
	"1772039-1"	"1772039-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Case vaccinated with Janssen on 5/28/2021. Tested positive for COVID on 9/16/2021. Admitted to Hospital on 9/21/2021 and expired on 10/02/2021 while still hospitalized."
	"1772066-1"	"1772066-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer. Second dose received on 3/22/2021. Tested positive for COVID on 9/14/2021. Admitted to Medical Center on 9/20/2021. Expired on 9/27/2021 while still hospitalized."
	"1772066-1"	"1772066-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer. Second dose received on 3/22/2021. Tested positive for COVID on 9/14/2021. Admitted to Medical Center on 9/20/2021. Expired on 9/27/2021 while still hospitalized."
	"1772066-1"	"1772066-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer. Second dose received on 3/22/2021. Tested positive for COVID on 9/14/2021. Admitted to Medical Center on 9/20/2021. Expired on 9/27/2021 while still hospitalized."
	"1772156-1"	"1772156-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Case fully vaccinated with Moderna . Last dose on 4/1/2021. Tested positive for COVID on 9/21/2021. Admitted Medical Center on 09/21/2021. Expired on 9/30/2021 while still hospitalized."
	"1772156-1"	"1772156-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Case fully vaccinated with Moderna . Last dose on 4/1/2021. Tested positive for COVID on 9/21/2021. Admitted Medical Center on 09/21/2021. Expired on 9/30/2021 while still hospitalized."
	"1772156-1"	"1772156-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Case fully vaccinated with Moderna . Last dose on 4/1/2021. Tested positive for COVID on 9/21/2021. Admitted Medical Center on 09/21/2021. Expired on 9/30/2021 while still hospitalized."
	"1776925-1"	"1776925-1"	"ACUTE MYOCARDIAL INFARCTION"	"10000891"	"65-79 years"	"65-79"	"Patient has hx of hypertension and Stage 3 kidney disease, obstructive sleep apnea with c/o palpitations, productive cough, congestion, fatigue, and weakness. Patient's HR was up and EKG revealed atrial fib with RVR.  He was given antibiotics and steroids He was discharged on 8/22 and was readmitted on 8/25 with worsening of symptoms  patient developed sepsis and returned with afib with RVR again. Patient's oxygen demand increased and worsening resp. failure patient was intubated and placed on a ventilator. Patient also had a NSTEMI Patient was terminally extubated and expired on 8/28."
	"1776925-1"	"1776925-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Patient has hx of hypertension and Stage 3 kidney disease, obstructive sleep apnea with c/o palpitations, productive cough, congestion, fatigue, and weakness. Patient's HR was up and EKG revealed atrial fib with RVR.  He was given antibiotics and steroids He was discharged on 8/22 and was readmitted on 8/25 with worsening of symptoms  patient developed sepsis and returned with afib with RVR again. Patient's oxygen demand increased and worsening resp. failure patient was intubated and placed on a ventilator. Patient also had a NSTEMI Patient was terminally extubated and expired on 8/28."
	"1776925-1"	"1776925-1"	"ATRIAL FIBRILLATION"	"10003658"	"65-79 years"	"65-79"	"Patient has hx of hypertension and Stage 3 kidney disease, obstructive sleep apnea with c/o palpitations, productive cough, congestion, fatigue, and weakness. Patient's HR was up and EKG revealed atrial fib with RVR.  He was given antibiotics and steroids He was discharged on 8/22 and was readmitted on 8/25 with worsening of symptoms  patient developed sepsis and returned with afib with RVR again. Patient's oxygen demand increased and worsening resp. failure patient was intubated and placed on a ventilator. Patient also had a NSTEMI Patient was terminally extubated and expired on 8/28."
	"1776925-1"	"1776925-1"	"COMPUTERISED TOMOGRAM ABNORMAL"	"10010235"	"65-79 years"	"65-79"	"Patient has hx of hypertension and Stage 3 kidney disease, obstructive sleep apnea with c/o palpitations, productive cough, congestion, fatigue, and weakness. Patient's HR was up and EKG revealed atrial fib with RVR.  He was given antibiotics and steroids He was discharged on 8/22 and was readmitted on 8/25 with worsening of symptoms  patient developed sepsis and returned with afib with RVR again. Patient's oxygen demand increased and worsening resp. failure patient was intubated and placed on a ventilator. Patient also had a NSTEMI Patient was terminally extubated and expired on 8/28."
	"1776925-1"	"1776925-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient has hx of hypertension and Stage 3 kidney disease, obstructive sleep apnea with c/o palpitations, productive cough, congestion, fatigue, and weakness. Patient's HR was up and EKG revealed atrial fib with RVR.  He was given antibiotics and steroids He was discharged on 8/22 and was readmitted on 8/25 with worsening of symptoms  patient developed sepsis and returned with afib with RVR again. Patient's oxygen demand increased and worsening resp. failure patient was intubated and placed on a ventilator. Patient also had a NSTEMI Patient was terminally extubated and expired on 8/28."
	"1776925-1"	"1776925-1"	"ELECTROCARDIOGRAM ABNORMAL"	"10014363"	"65-79 years"	"65-79"	"Patient has hx of hypertension and Stage 3 kidney disease, obstructive sleep apnea with c/o palpitations, productive cough, congestion, fatigue, and weakness. Patient's HR was up and EKG revealed atrial fib with RVR.  He was given antibiotics and steroids He was discharged on 8/22 and was readmitted on 8/25 with worsening of symptoms  patient developed sepsis and returned with afib with RVR again. Patient's oxygen demand increased and worsening resp. failure patient was intubated and placed on a ventilator. Patient also had a NSTEMI Patient was terminally extubated and expired on 8/28."
	"1776925-1"	"1776925-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"Patient has hx of hypertension and Stage 3 kidney disease, obstructive sleep apnea with c/o palpitations, productive cough, congestion, fatigue, and weakness. Patient's HR was up and EKG revealed atrial fib with RVR.  He was given antibiotics and steroids He was discharged on 8/22 and was readmitted on 8/25 with worsening of symptoms  patient developed sepsis and returned with afib with RVR again. Patient's oxygen demand increased and worsening resp. failure patient was intubated and placed on a ventilator. Patient also had a NSTEMI Patient was terminally extubated and expired on 8/28."
	"1776925-1"	"1776925-1"	"HEART RATE INCREASED"	"10019303"	"65-79 years"	"65-79"	"Patient has hx of hypertension and Stage 3 kidney disease, obstructive sleep apnea with c/o palpitations, productive cough, congestion, fatigue, and weakness. Patient's HR was up and EKG revealed atrial fib with RVR.  He was given antibiotics and steroids He was discharged on 8/22 and was readmitted on 8/25 with worsening of symptoms  patient developed sepsis and returned with afib with RVR again. Patient's oxygen demand increased and worsening resp. failure patient was intubated and placed on a ventilator. Patient also had a NSTEMI Patient was terminally extubated and expired on 8/28."
	"1776925-1"	"1776925-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"Patient has hx of hypertension and Stage 3 kidney disease, obstructive sleep apnea with c/o palpitations, productive cough, congestion, fatigue, and weakness. Patient's HR was up and EKG revealed atrial fib with RVR.  He was given antibiotics and steroids He was discharged on 8/22 and was readmitted on 8/25 with worsening of symptoms  patient developed sepsis and returned with afib with RVR again. Patient's oxygen demand increased and worsening resp. failure patient was intubated and placed on a ventilator. Patient also had a NSTEMI Patient was terminally extubated and expired on 8/28."
	"1776925-1"	"1776925-1"	"PALPITATIONS"	"10033557"	"65-79 years"	"65-79"	"Patient has hx of hypertension and Stage 3 kidney disease, obstructive sleep apnea with c/o palpitations, productive cough, congestion, fatigue, and weakness. Patient's HR was up and EKG revealed atrial fib with RVR.  He was given antibiotics and steroids He was discharged on 8/22 and was readmitted on 8/25 with worsening of symptoms  patient developed sepsis and returned with afib with RVR again. Patient's oxygen demand increased and worsening resp. failure patient was intubated and placed on a ventilator. Patient also had a NSTEMI Patient was terminally extubated and expired on 8/28."
	"1776925-1"	"1776925-1"	"PNEUMONIA BACTERIAL"	"10060946"	"65-79 years"	"65-79"	"Patient has hx of hypertension and Stage 3 kidney disease, obstructive sleep apnea with c/o palpitations, productive cough, congestion, fatigue, and weakness. Patient's HR was up and EKG revealed atrial fib with RVR.  He was given antibiotics and steroids He was discharged on 8/22 and was readmitted on 8/25 with worsening of symptoms  patient developed sepsis and returned with afib with RVR again. Patient's oxygen demand increased and worsening resp. failure patient was intubated and placed on a ventilator. Patient also had a NSTEMI Patient was terminally extubated and expired on 8/28."
	"1776925-1"	"1776925-1"	"PRODUCTIVE COUGH"	"10036790"	"65-79 years"	"65-79"	"Patient has hx of hypertension and Stage 3 kidney disease, obstructive sleep apnea with c/o palpitations, productive cough, congestion, fatigue, and weakness. Patient's HR was up and EKG revealed atrial fib with RVR.  He was given antibiotics and steroids He was discharged on 8/22 and was readmitted on 8/25 with worsening of symptoms  patient developed sepsis and returned with afib with RVR again. Patient's oxygen demand increased and worsening resp. failure patient was intubated and placed on a ventilator. Patient also had a NSTEMI Patient was terminally extubated and expired on 8/28."
	"1776925-1"	"1776925-1"	"RESPIRATORY FAILURE"	"10038695"	"65-79 years"	"65-79"	"Patient has hx of hypertension and Stage 3 kidney disease, obstructive sleep apnea with c/o palpitations, productive cough, congestion, fatigue, and weakness. Patient's HR was up and EKG revealed atrial fib with RVR.  He was given antibiotics and steroids He was discharged on 8/22 and was readmitted on 8/25 with worsening of symptoms  patient developed sepsis and returned with afib with RVR again. Patient's oxygen demand increased and worsening resp. failure patient was intubated and placed on a ventilator. Patient also had a NSTEMI Patient was terminally extubated and expired on 8/28."
	"1776925-1"	"1776925-1"	"RESPIRATORY TRACT CONGESTION"	"10052251"	"65-79 years"	"65-79"	"Patient has hx of hypertension and Stage 3 kidney disease, obstructive sleep apnea with c/o palpitations, productive cough, congestion, fatigue, and weakness. Patient's HR was up and EKG revealed atrial fib with RVR.  He was given antibiotics and steroids He was discharged on 8/22 and was readmitted on 8/25 with worsening of symptoms  patient developed sepsis and returned with afib with RVR again. Patient's oxygen demand increased and worsening resp. failure patient was intubated and placed on a ventilator. Patient also had a NSTEMI Patient was terminally extubated and expired on 8/28."
	"1776925-1"	"1776925-1"	"SEPSIS"	"10040047"	"65-79 years"	"65-79"	"Patient has hx of hypertension and Stage 3 kidney disease, obstructive sleep apnea with c/o palpitations, productive cough, congestion, fatigue, and weakness. Patient's HR was up and EKG revealed atrial fib with RVR.  He was given antibiotics and steroids He was discharged on 8/22 and was readmitted on 8/25 with worsening of symptoms  patient developed sepsis and returned with afib with RVR again. Patient's oxygen demand increased and worsening resp. failure patient was intubated and placed on a ventilator. Patient also had a NSTEMI Patient was terminally extubated and expired on 8/28."
	"1778854-1"	"1778854-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"COVID RELATED DEATH; BREAKTHROUGH CASE"
	"1778854-1"	"1778854-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"COVID RELATED DEATH; BREAKTHROUGH CASE"
	"1778854-1"	"1778854-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"COVID RELATED DEATH; BREAKTHROUGH CASE"
	"1778866-1"	"1778866-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"COVID RELATED DEATH; BREAKTHROUGH CASE.  VACCINE PROVIDED BY PHARMACY"
	"1778866-1"	"1778866-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"COVID RELATED DEATH; BREAKTHROUGH CASE.  VACCINE PROVIDED BY PHARMACY"
	"1778866-1"	"1778866-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"COVID RELATED DEATH; BREAKTHROUGH CASE.  VACCINE PROVIDED BY PHARMACY"
	"1779140-1"	"1779140-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"COVID RELATED DEATH; BREAKTHROUGH CASE"
	"1779140-1"	"1779140-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"COVID RELATED DEATH; BREAKTHROUGH CASE"
	"1779140-1"	"1779140-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"COVID RELATED DEATH; BREAKTHROUGH CASE"
	"1785593-1"	"1785593-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"ANAEMIA"	"10002034"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"COAGULOPATHY"	"10009802"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"CYANOSIS"	"10011703"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"EMBOLISM ARTERIAL"	"10014513"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"ENCEPHALOPATHY"	"10014625"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"EPISTAXIS"	"10015090"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"FAECES DISCOLOURED"	"10016100"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"HEART RATE DECREASED"	"10019301"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"MELAENA"	"10027141"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"MUCOSAL HAEMORRHAGE"	"10061298"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"PULMONARY EMBOLISM"	"10037377"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"RHABDOMYOLYSIS"	"10039020"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"SEPSIS"	"10040047"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"SHOCK"	"10040560"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"THROMBOCYTOPENIA"	"10043554"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"ULTRASOUND SCAN ABNORMAL"	"10061606"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1785593-1"	"1785593-1"	"UPPER AIRWAY OBSTRUCTION"	"10067775"	"65-79 years"	"65-79"	"Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure.  Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC.  Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis  with AKI.  Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities.  Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent.  Family aware and transitioned to comfort care."
	"1794807-1"	"1794807-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Patient received her booster dose from Pharmacy at an unknown time on 10/15/21.  Her husband reports she had been well throughout the day.  At some point, the patient began to complain of left sided chest pain and then became weak and had to lay down onto the floor.  She then became unresponsive and upon arrival of EMS, she was asystole.  She presented to our ED and we were able to get ROSC, but then the flight crew took off, the patient went into complete arrest again and was brought back to ED where resuscitation efforts continue, but the patient was pronounced dead at 2359."
	"1794807-1"	"1794807-1"	"BLOOD GASES"	"10005537"	"65-79 years"	"65-79"	"Patient received her booster dose from Pharmacy at an unknown time on 10/15/21.  Her husband reports she had been well throughout the day.  At some point, the patient began to complain of left sided chest pain and then became weak and had to lay down onto the floor.  She then became unresponsive and upon arrival of EMS, she was asystole.  She presented to our ED and we were able to get ROSC, but then the flight crew took off, the patient went into complete arrest again and was brought back to ED where resuscitation efforts continue, but the patient was pronounced dead at 2359."
	"1794807-1"	"1794807-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Patient received her booster dose from Pharmacy at an unknown time on 10/15/21.  Her husband reports she had been well throughout the day.  At some point, the patient began to complain of left sided chest pain and then became weak and had to lay down onto the floor.  She then became unresponsive and upon arrival of EMS, she was asystole.  She presented to our ED and we were able to get ROSC, but then the flight crew took off, the patient went into complete arrest again and was brought back to ED where resuscitation efforts continue, but the patient was pronounced dead at 2359."
	"1794807-1"	"1794807-1"	"CHEST PAIN"	"10008479"	"65-79 years"	"65-79"	"Patient received her booster dose from Pharmacy at an unknown time on 10/15/21.  Her husband reports she had been well throughout the day.  At some point, the patient began to complain of left sided chest pain and then became weak and had to lay down onto the floor.  She then became unresponsive and upon arrival of EMS, she was asystole.  She presented to our ED and we were able to get ROSC, but then the flight crew took off, the patient went into complete arrest again and was brought back to ED where resuscitation efforts continue, but the patient was pronounced dead at 2359."
	"1794807-1"	"1794807-1"	"CHEST X-RAY"	"10008498"	"65-79 years"	"65-79"	"Patient received her booster dose from Pharmacy at an unknown time on 10/15/21.  Her husband reports she had been well throughout the day.  At some point, the patient began to complain of left sided chest pain and then became weak and had to lay down onto the floor.  She then became unresponsive and upon arrival of EMS, she was asystole.  She presented to our ED and we were able to get ROSC, but then the flight crew took off, the patient went into complete arrest again and was brought back to ED where resuscitation efforts continue, but the patient was pronounced dead at 2359."
	"1794807-1"	"1794807-1"	"COAGULATION TEST"	"10063556"	"65-79 years"	"65-79"	"Patient received her booster dose from Pharmacy at an unknown time on 10/15/21.  Her husband reports she had been well throughout the day.  At some point, the patient began to complain of left sided chest pain and then became weak and had to lay down onto the floor.  She then became unresponsive and upon arrival of EMS, she was asystole.  She presented to our ED and we were able to get ROSC, but then the flight crew took off, the patient went into complete arrest again and was brought back to ED where resuscitation efforts continue, but the patient was pronounced dead at 2359."
	"1794807-1"	"1794807-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient received her booster dose from Pharmacy at an unknown time on 10/15/21.  Her husband reports she had been well throughout the day.  At some point, the patient began to complain of left sided chest pain and then became weak and had to lay down onto the floor.  She then became unresponsive and upon arrival of EMS, she was asystole.  She presented to our ED and we were able to get ROSC, but then the flight crew took off, the patient went into complete arrest again and was brought back to ED where resuscitation efforts continue, but the patient was pronounced dead at 2359."
	"1794807-1"	"1794807-1"	"ELECTROCARDIOGRAM"	"10014362"	"65-79 years"	"65-79"	"Patient received her booster dose from Pharmacy at an unknown time on 10/15/21.  Her husband reports she had been well throughout the day.  At some point, the patient began to complain of left sided chest pain and then became weak and had to lay down onto the floor.  She then became unresponsive and upon arrival of EMS, she was asystole.  She presented to our ED and we were able to get ROSC, but then the flight crew took off, the patient went into complete arrest again and was brought back to ED where resuscitation efforts continue, but the patient was pronounced dead at 2359."
	"1794807-1"	"1794807-1"	"FULL BLOOD COUNT"	"10017411"	"65-79 years"	"65-79"	"Patient received her booster dose from Pharmacy at an unknown time on 10/15/21.  Her husband reports she had been well throughout the day.  At some point, the patient began to complain of left sided chest pain and then became weak and had to lay down onto the floor.  She then became unresponsive and upon arrival of EMS, she was asystole.  She presented to our ED and we were able to get ROSC, but then the flight crew took off, the patient went into complete arrest again and was brought back to ED where resuscitation efforts continue, but the patient was pronounced dead at 2359."
	"1794807-1"	"1794807-1"	"METABOLIC FUNCTION TEST"	"10062191"	"65-79 years"	"65-79"	"Patient received her booster dose from Pharmacy at an unknown time on 10/15/21.  Her husband reports she had been well throughout the day.  At some point, the patient began to complain of left sided chest pain and then became weak and had to lay down onto the floor.  She then became unresponsive and upon arrival of EMS, she was asystole.  She presented to our ED and we were able to get ROSC, but then the flight crew took off, the patient went into complete arrest again and was brought back to ED where resuscitation efforts continue, but the patient was pronounced dead at 2359."
	"1794807-1"	"1794807-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Patient received her booster dose from Pharmacy at an unknown time on 10/15/21.  Her husband reports she had been well throughout the day.  At some point, the patient began to complain of left sided chest pain and then became weak and had to lay down onto the floor.  She then became unresponsive and upon arrival of EMS, she was asystole.  She presented to our ED and we were able to get ROSC, but then the flight crew took off, the patient went into complete arrest again and was brought back to ED where resuscitation efforts continue, but the patient was pronounced dead at 2359."
	"1794807-1"	"1794807-1"	"SARS-COV-2 TEST"	"10084354"	"65-79 years"	"65-79"	"Patient received her booster dose from Pharmacy at an unknown time on 10/15/21.  Her husband reports she had been well throughout the day.  At some point, the patient began to complain of left sided chest pain and then became weak and had to lay down onto the floor.  She then became unresponsive and upon arrival of EMS, she was asystole.  She presented to our ED and we were able to get ROSC, but then the flight crew took off, the patient went into complete arrest again and was brought back to ED where resuscitation efforts continue, but the patient was pronounced dead at 2359."
	"1794807-1"	"1794807-1"	"UNRESPONSIVE TO STIMULI"	"10045555"	"65-79 years"	"65-79"	"Patient received her booster dose from Pharmacy at an unknown time on 10/15/21.  Her husband reports she had been well throughout the day.  At some point, the patient began to complain of left sided chest pain and then became weak and had to lay down onto the floor.  She then became unresponsive and upon arrival of EMS, she was asystole.  She presented to our ED and we were able to get ROSC, but then the flight crew took off, the patient went into complete arrest again and was brought back to ED where resuscitation efforts continue, but the patient was pronounced dead at 2359."
	"1794987-1"	"1794987-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient expired from COVID-19 on 10/8/21 after being vaccinated"
	"1794987-1"	"1794987-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient expired from COVID-19 on 10/8/21 after being vaccinated"
	"1794987-1"	"1794987-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient expired from COVID-19 on 10/8/21 after being vaccinated"
	"1800765-1"	"1800765-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"Admitted on 9/26 with c/o generalized weakness. Covid + 2 weeks prior and also on admission. Noted hypernatremia without respiratory distress. Treated with hypertonic saline and followed by nephrology. Progressive respiratory distress and admitted to ICU on 10/3. Treated with remdesevir, dexamethasone and baricitinib. Noted bilateral pulmonary embolism treated with enoxaparin. Required intubation on ventilator. Developed unexplained  profound episodes of hypotension requiring vasoactive medications.  Suffered a PEA arrest during hypotensive episode. 2 rounds of CPR before ROSC achieved. on 10/18 noted atrial fib with rapid ventricular rate. Started on amiodarone and IV magnesium. Vasopressor infusions increased with no help and became pulseless. CPR unsuccessful."
	"1800765-1"	"1800765-1"	"ATRIAL FIBRILLATION"	"10003658"	"65-79 years"	"65-79"	"Admitted on 9/26 with c/o generalized weakness. Covid + 2 weeks prior and also on admission. Noted hypernatremia without respiratory distress. Treated with hypertonic saline and followed by nephrology. Progressive respiratory distress and admitted to ICU on 10/3. Treated with remdesevir, dexamethasone and baricitinib. Noted bilateral pulmonary embolism treated with enoxaparin. Required intubation on ventilator. Developed unexplained  profound episodes of hypotension requiring vasoactive medications.  Suffered a PEA arrest during hypotensive episode. 2 rounds of CPR before ROSC achieved. on 10/18 noted atrial fib with rapid ventricular rate. Started on amiodarone and IV magnesium. Vasopressor infusions increased with no help and became pulseless. CPR unsuccessful."
	"1800765-1"	"1800765-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Admitted on 9/26 with c/o generalized weakness. Covid + 2 weeks prior and also on admission. Noted hypernatremia without respiratory distress. Treated with hypertonic saline and followed by nephrology. Progressive respiratory distress and admitted to ICU on 10/3. Treated with remdesevir, dexamethasone and baricitinib. Noted bilateral pulmonary embolism treated with enoxaparin. Required intubation on ventilator. Developed unexplained  profound episodes of hypotension requiring vasoactive medications.  Suffered a PEA arrest during hypotensive episode. 2 rounds of CPR before ROSC achieved. on 10/18 noted atrial fib with rapid ventricular rate. Started on amiodarone and IV magnesium. Vasopressor infusions increased with no help and became pulseless. CPR unsuccessful."
	"1800765-1"	"1800765-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Admitted on 9/26 with c/o generalized weakness. Covid + 2 weeks prior and also on admission. Noted hypernatremia without respiratory distress. Treated with hypertonic saline and followed by nephrology. Progressive respiratory distress and admitted to ICU on 10/3. Treated with remdesevir, dexamethasone and baricitinib. Noted bilateral pulmonary embolism treated with enoxaparin. Required intubation on ventilator. Developed unexplained  profound episodes of hypotension requiring vasoactive medications.  Suffered a PEA arrest during hypotensive episode. 2 rounds of CPR before ROSC achieved. on 10/18 noted atrial fib with rapid ventricular rate. Started on amiodarone and IV magnesium. Vasopressor infusions increased with no help and became pulseless. CPR unsuccessful."
	"1800765-1"	"1800765-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Admitted on 9/26 with c/o generalized weakness. Covid + 2 weeks prior and also on admission. Noted hypernatremia without respiratory distress. Treated with hypertonic saline and followed by nephrology. Progressive respiratory distress and admitted to ICU on 10/3. Treated with remdesevir, dexamethasone and baricitinib. Noted bilateral pulmonary embolism treated with enoxaparin. Required intubation on ventilator. Developed unexplained  profound episodes of hypotension requiring vasoactive medications.  Suffered a PEA arrest during hypotensive episode. 2 rounds of CPR before ROSC achieved. on 10/18 noted atrial fib with rapid ventricular rate. Started on amiodarone and IV magnesium. Vasopressor infusions increased with no help and became pulseless. CPR unsuccessful."
	"1800765-1"	"1800765-1"	"HYPERNATRAEMIA"	"10020679"	"65-79 years"	"65-79"	"Admitted on 9/26 with c/o generalized weakness. Covid + 2 weeks prior and also on admission. Noted hypernatremia without respiratory distress. Treated with hypertonic saline and followed by nephrology. Progressive respiratory distress and admitted to ICU on 10/3. Treated with remdesevir, dexamethasone and baricitinib. Noted bilateral pulmonary embolism treated with enoxaparin. Required intubation on ventilator. Developed unexplained  profound episodes of hypotension requiring vasoactive medications.  Suffered a PEA arrest during hypotensive episode. 2 rounds of CPR before ROSC achieved. on 10/18 noted atrial fib with rapid ventricular rate. Started on amiodarone and IV magnesium. Vasopressor infusions increased with no help and became pulseless. CPR unsuccessful."
	"1800765-1"	"1800765-1"	"HYPOTENSION"	"10021097"	"65-79 years"	"65-79"	"Admitted on 9/26 with c/o generalized weakness. Covid + 2 weeks prior and also on admission. Noted hypernatremia without respiratory distress. Treated with hypertonic saline and followed by nephrology. Progressive respiratory distress and admitted to ICU on 10/3. Treated with remdesevir, dexamethasone and baricitinib. Noted bilateral pulmonary embolism treated with enoxaparin. Required intubation on ventilator. Developed unexplained  profound episodes of hypotension requiring vasoactive medications.  Suffered a PEA arrest during hypotensive episode. 2 rounds of CPR before ROSC achieved. on 10/18 noted atrial fib with rapid ventricular rate. Started on amiodarone and IV magnesium. Vasopressor infusions increased with no help and became pulseless. CPR unsuccessful."
	"1800765-1"	"1800765-1"	"INTENSIVE CARE"	"10022519"	"65-79 years"	"65-79"	"Admitted on 9/26 with c/o generalized weakness. Covid + 2 weeks prior and also on admission. Noted hypernatremia without respiratory distress. Treated with hypertonic saline and followed by nephrology. Progressive respiratory distress and admitted to ICU on 10/3. Treated with remdesevir, dexamethasone and baricitinib. Noted bilateral pulmonary embolism treated with enoxaparin. Required intubation on ventilator. Developed unexplained  profound episodes of hypotension requiring vasoactive medications.  Suffered a PEA arrest during hypotensive episode. 2 rounds of CPR before ROSC achieved. on 10/18 noted atrial fib with rapid ventricular rate. Started on amiodarone and IV magnesium. Vasopressor infusions increased with no help and became pulseless. CPR unsuccessful."
	"1800765-1"	"1800765-1"	"MECHANICAL VENTILATION"	"10067221"	"65-79 years"	"65-79"	"Admitted on 9/26 with c/o generalized weakness. Covid + 2 weeks prior and also on admission. Noted hypernatremia without respiratory distress. Treated with hypertonic saline and followed by nephrology. Progressive respiratory distress and admitted to ICU on 10/3. Treated with remdesevir, dexamethasone and baricitinib. Noted bilateral pulmonary embolism treated with enoxaparin. Required intubation on ventilator. Developed unexplained  profound episodes of hypotension requiring vasoactive medications.  Suffered a PEA arrest during hypotensive episode. 2 rounds of CPR before ROSC achieved. on 10/18 noted atrial fib with rapid ventricular rate. Started on amiodarone and IV magnesium. Vasopressor infusions increased with no help and became pulseless. CPR unsuccessful."
	"1800765-1"	"1800765-1"	"PULMONARY EMBOLISM"	"10037377"	"65-79 years"	"65-79"	"Admitted on 9/26 with c/o generalized weakness. Covid + 2 weeks prior and also on admission. Noted hypernatremia without respiratory distress. Treated with hypertonic saline and followed by nephrology. Progressive respiratory distress and admitted to ICU on 10/3. Treated with remdesevir, dexamethasone and baricitinib. Noted bilateral pulmonary embolism treated with enoxaparin. Required intubation on ventilator. Developed unexplained  profound episodes of hypotension requiring vasoactive medications.  Suffered a PEA arrest during hypotensive episode. 2 rounds of CPR before ROSC achieved. on 10/18 noted atrial fib with rapid ventricular rate. Started on amiodarone and IV magnesium. Vasopressor infusions increased with no help and became pulseless. CPR unsuccessful."
	"1800765-1"	"1800765-1"	"PULSE ABSENT"	"10037469"	"65-79 years"	"65-79"	"Admitted on 9/26 with c/o generalized weakness. Covid + 2 weeks prior and also on admission. Noted hypernatremia without respiratory distress. Treated with hypertonic saline and followed by nephrology. Progressive respiratory distress and admitted to ICU on 10/3. Treated with remdesevir, dexamethasone and baricitinib. Noted bilateral pulmonary embolism treated with enoxaparin. Required intubation on ventilator. Developed unexplained  profound episodes of hypotension requiring vasoactive medications.  Suffered a PEA arrest during hypotensive episode. 2 rounds of CPR before ROSC achieved. on 10/18 noted atrial fib with rapid ventricular rate. Started on amiodarone and IV magnesium. Vasopressor infusions increased with no help and became pulseless. CPR unsuccessful."
	"1800765-1"	"1800765-1"	"PULSELESS ELECTRICAL ACTIVITY"	"10058151"	"65-79 years"	"65-79"	"Admitted on 9/26 with c/o generalized weakness. Covid + 2 weeks prior and also on admission. Noted hypernatremia without respiratory distress. Treated with hypertonic saline and followed by nephrology. Progressive respiratory distress and admitted to ICU on 10/3. Treated with remdesevir, dexamethasone and baricitinib. Noted bilateral pulmonary embolism treated with enoxaparin. Required intubation on ventilator. Developed unexplained  profound episodes of hypotension requiring vasoactive medications.  Suffered a PEA arrest during hypotensive episode. 2 rounds of CPR before ROSC achieved. on 10/18 noted atrial fib with rapid ventricular rate. Started on amiodarone and IV magnesium. Vasopressor infusions increased with no help and became pulseless. CPR unsuccessful."
	"1800765-1"	"1800765-1"	"RESPIRATORY DISTRESS"	"10038687"	"65-79 years"	"65-79"	"Admitted on 9/26 with c/o generalized weakness. Covid + 2 weeks prior and also on admission. Noted hypernatremia without respiratory distress. Treated with hypertonic saline and followed by nephrology. Progressive respiratory distress and admitted to ICU on 10/3. Treated with remdesevir, dexamethasone and baricitinib. Noted bilateral pulmonary embolism treated with enoxaparin. Required intubation on ventilator. Developed unexplained  profound episodes of hypotension requiring vasoactive medications.  Suffered a PEA arrest during hypotensive episode. 2 rounds of CPR before ROSC achieved. on 10/18 noted atrial fib with rapid ventricular rate. Started on amiodarone and IV magnesium. Vasopressor infusions increased with no help and became pulseless. CPR unsuccessful."
	"1800765-1"	"1800765-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Admitted on 9/26 with c/o generalized weakness. Covid + 2 weeks prior and also on admission. Noted hypernatremia without respiratory distress. Treated with hypertonic saline and followed by nephrology. Progressive respiratory distress and admitted to ICU on 10/3. Treated with remdesevir, dexamethasone and baricitinib. Noted bilateral pulmonary embolism treated with enoxaparin. Required intubation on ventilator. Developed unexplained  profound episodes of hypotension requiring vasoactive medications.  Suffered a PEA arrest during hypotensive episode. 2 rounds of CPR before ROSC achieved. on 10/18 noted atrial fib with rapid ventricular rate. Started on amiodarone and IV magnesium. Vasopressor infusions increased with no help and became pulseless. CPR unsuccessful."
	"1800765-1"	"1800765-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Admitted on 9/26 with c/o generalized weakness. Covid + 2 weeks prior and also on admission. Noted hypernatremia without respiratory distress. Treated with hypertonic saline and followed by nephrology. Progressive respiratory distress and admitted to ICU on 10/3. Treated with remdesevir, dexamethasone and baricitinib. Noted bilateral pulmonary embolism treated with enoxaparin. Required intubation on ventilator. Developed unexplained  profound episodes of hypotension requiring vasoactive medications.  Suffered a PEA arrest during hypotensive episode. 2 rounds of CPR before ROSC achieved. on 10/18 noted atrial fib with rapid ventricular rate. Started on amiodarone and IV magnesium. Vasopressor infusions increased with no help and became pulseless. CPR unsuccessful."
	"1800859-1"	"1800859-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient fully vacinated. Admitted to hopital on 09/02/2021. Expired on 09/16/2021"
	"1800859-1"	"1800859-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient fully vacinated. Admitted to hopital on 09/02/2021. Expired on 09/16/2021"
	"1800859-1"	"1800859-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Patient fully vacinated. Admitted to hopital on 09/02/2021. Expired on 09/16/2021"
	"1808415-1"	"1808415-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer with second dose administered on 2/18/2021. Tested positive for COVID on 9/24/2021. Admitted to Hospital on 9/24/2021 and expired on 10/16/2021 while still hospitalized."
	"1808415-1"	"1808415-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer with second dose administered on 2/18/2021. Tested positive for COVID on 9/24/2021. Admitted to Hospital on 9/24/2021 and expired on 10/16/2021 while still hospitalized."
	"1808415-1"	"1808415-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Case fully vaccinated with Pfizer with second dose administered on 2/18/2021. Tested positive for COVID on 9/24/2021. Admitted to Hospital on 9/24/2021 and expired on 10/16/2021 while still hospitalized."
	"1815001-1"	"1815001-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"COVID RELATED DEATH; BREAKTHROUGH CASE"
	"1815001-1"	"1815001-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"COVID RELATED DEATH; BREAKTHROUGH CASE"
	"1815001-1"	"1815001-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"COVID RELATED DEATH; BREAKTHROUGH CASE"
	"1815217-1"	"1815217-1"	"ACUTE KIDNEY INJURY"	"10069339"	"65-79 years"	"65-79"	"This is a case of breakthrough COVID-19 disease that resulted in death.   The patient became symptomatic while on a trip out of state. Several other people on this trip were also ill with COVID-19.   This case was vaccinated with the Pfizer product on 02/19/2021 and 03/13/2021. The case became symptomatic for COVID-19 on 09/21/2021 and experienced symptoms of diarrhea, general weakness, fatigue, and sore throat. The exact timeline here is not clear, but over the course of the following days, the case developed difficulty breathing and was admitted to the hospital on 09/27/2021.. The case subsequently died on 10/01/2021.   The death certificate details are as follows:  Part I Cause of Death A: Acute Hypoxic Respiratory Failure B: COVID 19 Pneumonia; Adult Respiratory Distress Syndrome Part II Other Significant Conditions: Acute Kidney Failure; Acute Metabolic Encephalopathy"
	"1815217-1"	"1815217-1"	"ACUTE RESPIRATORY DISTRESS SYNDROME"	"10001052"	"65-79 years"	"65-79"	"This is a case of breakthrough COVID-19 disease that resulted in death.   The patient became symptomatic while on a trip out of state. Several other people on this trip were also ill with COVID-19.   This case was vaccinated with the Pfizer product on 02/19/2021 and 03/13/2021. The case became symptomatic for COVID-19 on 09/21/2021 and experienced symptoms of diarrhea, general weakness, fatigue, and sore throat. The exact timeline here is not clear, but over the course of the following days, the case developed difficulty breathing and was admitted to the hospital on 09/27/2021.. The case subsequently died on 10/01/2021.   The death certificate details are as follows:  Part I Cause of Death A: Acute Hypoxic Respiratory Failure B: COVID 19 Pneumonia; Adult Respiratory Distress Syndrome Part II Other Significant Conditions: Acute Kidney Failure; Acute Metabolic Encephalopathy"
	"1815217-1"	"1815217-1"	"ACUTE RESPIRATORY FAILURE"	"10001053"	"65-79 years"	"65-79"	"This is a case of breakthrough COVID-19 disease that resulted in death.   The patient became symptomatic while on a trip out of state. Several other people on this trip were also ill with COVID-19.   This case was vaccinated with the Pfizer product on 02/19/2021 and 03/13/2021. The case became symptomatic for COVID-19 on 09/21/2021 and experienced symptoms of diarrhea, general weakness, fatigue, and sore throat. The exact timeline here is not clear, but over the course of the following days, the case developed difficulty breathing and was admitted to the hospital on 09/27/2021.. The case subsequently died on 10/01/2021.   The death certificate details are as follows:  Part I Cause of Death A: Acute Hypoxic Respiratory Failure B: COVID 19 Pneumonia; Adult Respiratory Distress Syndrome Part II Other Significant Conditions: Acute Kidney Failure; Acute Metabolic Encephalopathy"
	"1815217-1"	"1815217-1"	"ASTHENIA"	"10003549"	"65-79 years"	"65-79"	"This is a case of breakthrough COVID-19 disease that resulted in death.   The patient became symptomatic while on a trip out of state. Several other people on this trip were also ill with COVID-19.   This case was vaccinated with the Pfizer product on 02/19/2021 and 03/13/2021. The case became symptomatic for COVID-19 on 09/21/2021 and experienced symptoms of diarrhea, general weakness, fatigue, and sore throat. The exact timeline here is not clear, but over the course of the following days, the case developed difficulty breathing and was admitted to the hospital on 09/27/2021.. The case subsequently died on 10/01/2021.   The death certificate details are as follows:  Part I Cause of Death A: Acute Hypoxic Respiratory Failure B: COVID 19 Pneumonia; Adult Respiratory Distress Syndrome Part II Other Significant Conditions: Acute Kidney Failure; Acute Metabolic Encephalopathy"
	"1815217-1"	"1815217-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"This is a case of breakthrough COVID-19 disease that resulted in death.   The patient became symptomatic while on a trip out of state. Several other people on this trip were also ill with COVID-19.   This case was vaccinated with the Pfizer product on 02/19/2021 and 03/13/2021. The case became symptomatic for COVID-19 on 09/21/2021 and experienced symptoms of diarrhea, general weakness, fatigue, and sore throat. The exact timeline here is not clear, but over the course of the following days, the case developed difficulty breathing and was admitted to the hospital on 09/27/2021.. The case subsequently died on 10/01/2021.   The death certificate details are as follows:  Part I Cause of Death A: Acute Hypoxic Respiratory Failure B: COVID 19 Pneumonia; Adult Respiratory Distress Syndrome Part II Other Significant Conditions: Acute Kidney Failure; Acute Metabolic Encephalopathy"
	"1815217-1"	"1815217-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"This is a case of breakthrough COVID-19 disease that resulted in death.   The patient became symptomatic while on a trip out of state. Several other people on this trip were also ill with COVID-19.   This case was vaccinated with the Pfizer product on 02/19/2021 and 03/13/2021. The case became symptomatic for COVID-19 on 09/21/2021 and experienced symptoms of diarrhea, general weakness, fatigue, and sore throat. The exact timeline here is not clear, but over the course of the following days, the case developed difficulty breathing and was admitted to the hospital on 09/27/2021.. The case subsequently died on 10/01/2021.   The death certificate details are as follows:  Part I Cause of Death A: Acute Hypoxic Respiratory Failure B: COVID 19 Pneumonia; Adult Respiratory Distress Syndrome Part II Other Significant Conditions: Acute Kidney Failure; Acute Metabolic Encephalopathy"
	"1815217-1"	"1815217-1"	"COVID-19 PNEUMONIA"	"10084380"	"65-79 years"	"65-79"	"This is a case of breakthrough COVID-19 disease that resulted in death.   The patient became symptomatic while on a trip out of state. Several other people on this trip were also ill with COVID-19.   This case was vaccinated with the Pfizer product on 02/19/2021 and 03/13/2021. The case became symptomatic for COVID-19 on 09/21/2021 and experienced symptoms of diarrhea, general weakness, fatigue, and sore throat. The exact timeline here is not clear, but over the course of the following days, the case developed difficulty breathing and was admitted to the hospital on 09/27/2021.. The case subsequently died on 10/01/2021.   The death certificate details are as follows:  Part I Cause of Death A: Acute Hypoxic Respiratory Failure B: COVID 19 Pneumonia; Adult Respiratory Distress Syndrome Part II Other Significant Conditions: Acute Kidney Failure; Acute Metabolic Encephalopathy"
	"1815217-1"	"1815217-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"This is a case of breakthrough COVID-19 disease that resulted in death.   The patient became symptomatic while on a trip out of state. Several other people on this trip were also ill with COVID-19.   This case was vaccinated with the Pfizer product on 02/19/2021 and 03/13/2021. The case became symptomatic for COVID-19 on 09/21/2021 and experienced symptoms of diarrhea, general weakness, fatigue, and sore throat. The exact timeline here is not clear, but over the course of the following days, the case developed difficulty breathing and was admitted to the hospital on 09/27/2021.. The case subsequently died on 10/01/2021.   The death certificate details are as follows:  Part I Cause of Death A: Acute Hypoxic Respiratory Failure B: COVID 19 Pneumonia; Adult Respiratory Distress Syndrome Part II Other Significant Conditions: Acute Kidney Failure; Acute Metabolic Encephalopathy"
	"1815217-1"	"1815217-1"	"DIARRHOEA"	"10012735"	"65-79 years"	"65-79"	"This is a case of breakthrough COVID-19 disease that resulted in death.   The patient became symptomatic while on a trip out of state. Several other people on this trip were also ill with COVID-19.   This case was vaccinated with the Pfizer product on 02/19/2021 and 03/13/2021. The case became symptomatic for COVID-19 on 09/21/2021 and experienced symptoms of diarrhea, general weakness, fatigue, and sore throat. The exact timeline here is not clear, but over the course of the following days, the case developed difficulty breathing and was admitted to the hospital on 09/27/2021.. The case subsequently died on 10/01/2021.   The death certificate details are as follows:  Part I Cause of Death A: Acute Hypoxic Respiratory Failure B: COVID 19 Pneumonia; Adult Respiratory Distress Syndrome Part II Other Significant Conditions: Acute Kidney Failure; Acute Metabolic Encephalopathy"
	"1815217-1"	"1815217-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"This is a case of breakthrough COVID-19 disease that resulted in death.   The patient became symptomatic while on a trip out of state. Several other people on this trip were also ill with COVID-19.   This case was vaccinated with the Pfizer product on 02/19/2021 and 03/13/2021. The case became symptomatic for COVID-19 on 09/21/2021 and experienced symptoms of diarrhea, general weakness, fatigue, and sore throat. The exact timeline here is not clear, but over the course of the following days, the case developed difficulty breathing and was admitted to the hospital on 09/27/2021.. The case subsequently died on 10/01/2021.   The death certificate details are as follows:  Part I Cause of Death A: Acute Hypoxic Respiratory Failure B: COVID 19 Pneumonia; Adult Respiratory Distress Syndrome Part II Other Significant Conditions: Acute Kidney Failure; Acute Metabolic Encephalopathy"
	"1815217-1"	"1815217-1"	"FATIGUE"	"10016256"	"65-79 years"	"65-79"	"This is a case of breakthrough COVID-19 disease that resulted in death.   The patient became symptomatic while on a trip out of state. Several other people on this trip were also ill with COVID-19.   This case was vaccinated with the Pfizer product on 02/19/2021 and 03/13/2021. The case became symptomatic for COVID-19 on 09/21/2021 and experienced symptoms of diarrhea, general weakness, fatigue, and sore throat. The exact timeline here is not clear, but over the course of the following days, the case developed difficulty breathing and was admitted to the hospital on 09/27/2021.. The case subsequently died on 10/01/2021.   The death certificate details are as follows:  Part I Cause of Death A: Acute Hypoxic Respiratory Failure B: COVID 19 Pneumonia; Adult Respiratory Distress Syndrome Part II Other Significant Conditions: Acute Kidney Failure; Acute Metabolic Encephalopathy"
	"1815217-1"	"1815217-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"This is a case of breakthrough COVID-19 disease that resulted in death.   The patient became symptomatic while on a trip out of state. Several other people on this trip were also ill with COVID-19.   This case was vaccinated with the Pfizer product on 02/19/2021 and 03/13/2021. The case became symptomatic for COVID-19 on 09/21/2021 and experienced symptoms of diarrhea, general weakness, fatigue, and sore throat. The exact timeline here is not clear, but over the course of the following days, the case developed difficulty breathing and was admitted to the hospital on 09/27/2021.. The case subsequently died on 10/01/2021.   The death certificate details are as follows:  Part I Cause of Death A: Acute Hypoxic Respiratory Failure B: COVID 19 Pneumonia; Adult Respiratory Distress Syndrome Part II Other Significant Conditions: Acute Kidney Failure; Acute Metabolic Encephalopathy"
	"1815217-1"	"1815217-1"	"METABOLIC ENCEPHALOPATHY"	"10062190"	"65-79 years"	"65-79"	"This is a case of breakthrough COVID-19 disease that resulted in death.   The patient became symptomatic while on a trip out of state. Several other people on this trip were also ill with COVID-19.   This case was vaccinated with the Pfizer product on 02/19/2021 and 03/13/2021. The case became symptomatic for COVID-19 on 09/21/2021 and experienced symptoms of diarrhea, general weakness, fatigue, and sore throat. The exact timeline here is not clear, but over the course of the following days, the case developed difficulty breathing and was admitted to the hospital on 09/27/2021.. The case subsequently died on 10/01/2021.   The death certificate details are as follows:  Part I Cause of Death A: Acute Hypoxic Respiratory Failure B: COVID 19 Pneumonia; Adult Respiratory Distress Syndrome Part II Other Significant Conditions: Acute Kidney Failure; Acute Metabolic Encephalopathy"
	"1815217-1"	"1815217-1"	"OROPHARYNGEAL PAIN"	"10068319"	"65-79 years"	"65-79"	"This is a case of breakthrough COVID-19 disease that resulted in death.   The patient became symptomatic while on a trip out of state. Several other people on this trip were also ill with COVID-19.   This case was vaccinated with the Pfizer product on 02/19/2021 and 03/13/2021. The case became symptomatic for COVID-19 on 09/21/2021 and experienced symptoms of diarrhea, general weakness, fatigue, and sore throat. The exact timeline here is not clear, but over the course of the following days, the case developed difficulty breathing and was admitted to the hospital on 09/27/2021.. The case subsequently died on 10/01/2021.   The death certificate details are as follows:  Part I Cause of Death A: Acute Hypoxic Respiratory Failure B: COVID 19 Pneumonia; Adult Respiratory Distress Syndrome Part II Other Significant Conditions: Acute Kidney Failure; Acute Metabolic Encephalopathy"
	"1815217-1"	"1815217-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"This is a case of breakthrough COVID-19 disease that resulted in death.   The patient became symptomatic while on a trip out of state. Several other people on this trip were also ill with COVID-19.   This case was vaccinated with the Pfizer product on 02/19/2021 and 03/13/2021. The case became symptomatic for COVID-19 on 09/21/2021 and experienced symptoms of diarrhea, general weakness, fatigue, and sore throat. The exact timeline here is not clear, but over the course of the following days, the case developed difficulty breathing and was admitted to the hospital on 09/27/2021.. The case subsequently died on 10/01/2021.   The death certificate details are as follows:  Part I Cause of Death A: Acute Hypoxic Respiratory Failure B: COVID 19 Pneumonia; Adult Respiratory Distress Syndrome Part II Other Significant Conditions: Acute Kidney Failure; Acute Metabolic Encephalopathy"
	"1815217-1"	"1815217-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"This is a case of breakthrough COVID-19 disease that resulted in death.   The patient became symptomatic while on a trip out of state. Several other people on this trip were also ill with COVID-19.   This case was vaccinated with the Pfizer product on 02/19/2021 and 03/13/2021. The case became symptomatic for COVID-19 on 09/21/2021 and experienced symptoms of diarrhea, general weakness, fatigue, and sore throat. The exact timeline here is not clear, but over the course of the following days, the case developed difficulty breathing and was admitted to the hospital on 09/27/2021.. The case subsequently died on 10/01/2021.   The death certificate details are as follows:  Part I Cause of Death A: Acute Hypoxic Respiratory Failure B: COVID 19 Pneumonia; Adult Respiratory Distress Syndrome Part II Other Significant Conditions: Acute Kidney Failure; Acute Metabolic Encephalopathy"
	"1818134-1"	"1818134-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Symptomatic:(unknown onset date) subjective fevers"
	"1818134-1"	"1818134-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"Symptomatic:(unknown onset date) subjective fevers"
	"1818134-1"	"1818134-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Symptomatic:(unknown onset date) subjective fevers"
	"1825543-1"	"1825543-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"Covid-19 diagnosis and symptom onset 9/7/2021 including cough, pneumonia"
	"1825543-1"	"1825543-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Covid-19 diagnosis and symptom onset 9/7/2021 including cough, pneumonia"
	"1825543-1"	"1825543-1"	"PNEUMONIA"	"10035664"	"65-79 years"	"65-79"	"Covid-19 diagnosis and symptom onset 9/7/2021 including cough, pneumonia"
	"1825543-1"	"1825543-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Covid-19 diagnosis and symptom onset 9/7/2021 including cough, pneumonia"
	"1828586-1"	"1828586-1"	"DEAFNESS"	"10011878"	"65-79 years"	"65-79"	"Vertigo, Dizziness, Hearing loss progressing to kidney and liver failure and death."
	"1828586-1"	"1828586-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Vertigo, Dizziness, Hearing loss progressing to kidney and liver failure and death."
	"1828586-1"	"1828586-1"	"DIZZINESS"	"10013573"	"65-79 years"	"65-79"	"Vertigo, Dizziness, Hearing loss progressing to kidney and liver failure and death."
	"1828586-1"	"1828586-1"	"HEPATIC FAILURE"	"10019663"	"65-79 years"	"65-79"	"Vertigo, Dizziness, Hearing loss progressing to kidney and liver failure and death."
	"1828586-1"	"1828586-1"	"LABORATORY TEST"	"10059938"	"65-79 years"	"65-79"	"Vertigo, Dizziness, Hearing loss progressing to kidney and liver failure and death."
	"1828586-1"	"1828586-1"	"RENAL FAILURE"	"10038435"	"65-79 years"	"65-79"	"Vertigo, Dizziness, Hearing loss progressing to kidney and liver failure and death."
	"1828586-1"	"1828586-1"	"VERTIGO"	"10047340"	"65-79 years"	"65-79"	"Vertigo, Dizziness, Hearing loss progressing to kidney and liver failure and death."
	"1828596-1"	"1828596-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"COVID RELATED DEATH; BREAKTHROUGH CASE"
	"1828596-1"	"1828596-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"COVID RELATED DEATH; BREAKTHROUGH CASE"
	"1828596-1"	"1828596-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"COVID RELATED DEATH; BREAKTHROUGH CASE"
	"1828795-1"	"1828795-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Case fully vaccinated with Moderna. Second dose administered on 4/23/2021. Tested positive for COVID on 10/12/2021. Admitted to Medical Center on 10/21/2021 and expired on 10/27/2021 while still hospitalized."
	"1828795-1"	"1828795-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Case fully vaccinated with Moderna. Second dose administered on 4/23/2021. Tested positive for COVID on 10/12/2021. Admitted to Medical Center on 10/21/2021 and expired on 10/27/2021 while still hospitalized."
	"1828795-1"	"1828795-1"	"INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION"	"10081572"	"65-79 years"	"65-79"	"Case fully vaccinated with Moderna. Second dose administered on 4/23/2021. Tested positive for COVID on 10/12/2021. Admitted to Medical Center on 10/21/2021 and expired on 10/27/2021 while still hospitalized."
	"1828795-1"	"1828795-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Case fully vaccinated with Moderna. Second dose administered on 4/23/2021. Tested positive for COVID on 10/12/2021. Admitted to Medical Center on 10/21/2021 and expired on 10/27/2021 while still hospitalized."
	"1828802-1"	"1828802-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"Death on  10/27/2021"
	"1828802-1"	"1828802-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Death on  10/27/2021"
	"1828802-1"	"1828802-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death on  10/27/2021"
	"1828802-1"	"1828802-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"Death on  10/27/2021"
	"1831095-1"	"1831095-1"	"CARDIAC ARREST"	"10007515"	"65-79 years"	"65-79"	"Cardiac arrest one week later, on 03Mar died 3 months later; Cardiac arrest one week later, on 03Mar died 3 months later; This is a spontaneous report from a contactable consumer. A 73-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in Arm Right on 24Feb2021 02:00 (at the age of 73-years-old) (Batch/Lot Number: En6302) as DOSE 1, SINGLE for covid-19 immunisation. The patient's medical history was not reported. The patient has no known allergies. The patient did not have covid prior vaccination and was not covid tested post vaccination. On 03Mar2021 07:00, the patient experienced cardiac arrest one week later, on 03Mar2021 died 3 months later. Therapeutic measures were taken as a result of the events. The patient died on 03Mar2021.  It was not reported if an autopsy was performed. The outcome of the event cardiac arrest was not recovered.   Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: Cardiac arrest one week later, on 03Mar died 3 months later"
	"1831095-1"	"1831095-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Cardiac arrest one week later, on 03Mar died 3 months later; Cardiac arrest one week later, on 03Mar died 3 months later; This is a spontaneous report from a contactable consumer. A 73-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in Arm Right on 24Feb2021 02:00 (at the age of 73-years-old) (Batch/Lot Number: En6302) as DOSE 1, SINGLE for covid-19 immunisation. The patient's medical history was not reported. The patient has no known allergies. The patient did not have covid prior vaccination and was not covid tested post vaccination. On 03Mar2021 07:00, the patient experienced cardiac arrest one week later, on 03Mar2021 died 3 months later. Therapeutic measures were taken as a result of the events. The patient died on 03Mar2021.  It was not reported if an autopsy was performed. The outcome of the event cardiac arrest was not recovered.   Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: Cardiac arrest one week later, on 03Mar died 3 months later"
	"1836360-1"	"1836360-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"SHORTNESS OF BREATH with hypoxia, D satting into the 80s when she sleeps at night, now at about the 11th day of illness with COVID-19.Diagnosed with covid on 10/10, presented to outside hospital on 10/12, after having been sick for about 9 days."
	"1836360-1"	"1836360-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"SHORTNESS OF BREATH with hypoxia, D satting into the 80s when she sleeps at night, now at about the 11th day of illness with COVID-19.Diagnosed with covid on 10/10, presented to outside hospital on 10/12, after having been sick for about 9 days."
	"1836360-1"	"1836360-1"	"HYPOXIA"	"10021143"	"65-79 years"	"65-79"	"SHORTNESS OF BREATH with hypoxia, D satting into the 80s when she sleeps at night, now at about the 11th day of illness with COVID-19.Diagnosed with covid on 10/10, presented to outside hospital on 10/12, after having been sick for about 9 days."
	"1836360-1"	"1836360-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"SHORTNESS OF BREATH with hypoxia, D satting into the 80s when she sleeps at night, now at about the 11th day of illness with COVID-19.Diagnosed with covid on 10/10, presented to outside hospital on 10/12, after having been sick for about 9 days."
	"1836360-1"	"1836360-1"	"OXYGEN SATURATION DECREASED"	"10033318"	"65-79 years"	"65-79"	"SHORTNESS OF BREATH with hypoxia, D satting into the 80s when she sleeps at night, now at about the 11th day of illness with COVID-19.Diagnosed with covid on 10/10, presented to outside hospital on 10/12, after having been sick for about 9 days."
	"1850901-1"	"1850901-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"patient vaccinated with janseen vaccine on 6/8/21. tested positive for covid on 10/26/2021. admitted to Hospital on 10/26/2021. Expired on 10/31/2021 while still hospitalized."
	"1850901-1"	"1850901-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"patient vaccinated with janseen vaccine on 6/8/21. tested positive for covid on 10/26/2021. admitted to Hospital on 10/26/2021. Expired on 10/31/2021 while still hospitalized."
	"1850901-1"	"1850901-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"patient vaccinated with janseen vaccine on 6/8/21. tested positive for covid on 10/26/2021. admitted to Hospital on 10/26/2021. Expired on 10/31/2021 while still hospitalized."
	"1850995-1"	"1850995-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"case fully vaccinated with moderna. last dose on 3/13/2021. Tested positive for covid on 10/8/2021. Admitted to Hospital on 10/29/2021. Expired on 11/04/2021 while still hospitalized."
	"1850995-1"	"1850995-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"case fully vaccinated with moderna. last dose on 3/13/2021. Tested positive for covid on 10/8/2021. Admitted to Hospital on 10/29/2021. Expired on 11/04/2021 while still hospitalized."
	"1850995-1"	"1850995-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"case fully vaccinated with moderna. last dose on 3/13/2021. Tested positive for covid on 10/8/2021. Admitted to Hospital on 10/29/2021. Expired on 11/04/2021 while still hospitalized."
	"1853287-1"	"1853287-1"	"DIARRHOEA"	"10012735"	"65-79 years"	"65-79"	"diarrhea; nausea; fever; Dyspnoea/shortness of breath; pneumonia; This is a spontaneous report from a contactable other health professional (patient's child). A 74-year-old male patient received bnt162b2 (COMIRNATY), dose 1 intramuscular, administered in arm left on 08Mar2021 12:00 (Lot Number: unknown) as single dose for covid-19 immunisation at the age of 74-year-old. Medical history included colitis. There was no other vaccine in four weeks. Patient had no known allergies and no covid prior vaccination. Concomitant medications included azathioprine sodium (IMURAN) from an unspecified date and ongoing taken for colitis ulcerosa and steroid etc. The patient experienced diarrhea, nausea, fever, dyspnoea/shortness of breath and pneumonia on 10Mar2021 at 01:00 AM. The patient was hospitalized for events for 4 days.  Events resulted in physician or other hcp office visit, emergency or emergency medicine, hospital treatment and patient died. He had negative COVID test. The patient underwent lab tests and procedures which included nasal swab: negative on 25Mar2021. The patient died on 28Mar2021.  An autopsy was not performed. Patient received oxygen and antibiotics therapy for events. Outcome of events was fatal.   Events occurred in a country different from that of the reporter.  This may be a duplicate if the reporter also submitted directly to his/her local agency.  The lot number for BNT162B2 was not provided and will be requested during follow up.; Sender's Comments: As there is limited information in the case provided, the causal association between the events and the suspect drug BNT162B2 cannot be excluded. The case will be reassessed once new information is available.  The impact of this report on the benefit-risk profile of the Pfizer product and on the conduct of the study 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 regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Pneumonia; Dyspnoea/shortness of breath; fever; nausea; diarrhea"
	"1853287-1"	"1853287-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"diarrhea; nausea; fever; Dyspnoea/shortness of breath; pneumonia; This is a spontaneous report from a contactable other health professional (patient's child). A 74-year-old male patient received bnt162b2 (COMIRNATY), dose 1 intramuscular, administered in arm left on 08Mar2021 12:00 (Lot Number: unknown) as single dose for covid-19 immunisation at the age of 74-year-old. Medical history included colitis. There was no other vaccine in four weeks. Patient had no known allergies and no covid prior vaccination. Concomitant medications included azathioprine sodium (IMURAN) from an unspecified date and ongoing taken for colitis ulcerosa and steroid etc. The patient experienced diarrhea, nausea, fever, dyspnoea/shortness of breath and pneumonia on 10Mar2021 at 01:00 AM. The patient was hospitalized for events for 4 days.  Events resulted in physician or other hcp office visit, emergency or emergency medicine, hospital treatment and patient died. He had negative COVID test. The patient underwent lab tests and procedures which included nasal swab: negative on 25Mar2021. The patient died on 28Mar2021.  An autopsy was not performed. Patient received oxygen and antibiotics therapy for events. Outcome of events was fatal.   Events occurred in a country different from that of the reporter.  This may be a duplicate if the reporter also submitted directly to his/her local agency.  The lot number for BNT162B2 was not provided and will be requested during follow up.; Sender's Comments: As there is limited information in the case provided, the causal association between the events and the suspect drug BNT162B2 cannot be excluded. The case will be reassessed once new information is available.  The impact of this report on the benefit-risk profile of the Pfizer product and on the conduct of the study 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 regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Pneumonia; Dyspnoea/shortness of breath; fever; nausea; diarrhea"
	"1853287-1"	"1853287-1"	"NAUSEA"	"10028813"	"65-79 years"	"65-79"	"diarrhea; nausea; fever; Dyspnoea/shortness of breath; pneumonia; This is a spontaneous report from a contactable other health professional (patient's child). A 74-year-old male patient received bnt162b2 (COMIRNATY), dose 1 intramuscular, administered in arm left on 08Mar2021 12:00 (Lot Number: unknown) as single dose for covid-19 immunisation at the age of 74-year-old. Medical history included colitis. There was no other vaccine in four weeks. Patient had no known allergies and no covid prior vaccination. Concomitant medications included azathioprine sodium (IMURAN) from an unspecified date and ongoing taken for colitis ulcerosa and steroid etc. The patient experienced diarrhea, nausea, fever, dyspnoea/shortness of breath and pneumonia on 10Mar2021 at 01:00 AM. The patient was hospitalized for events for 4 days.  Events resulted in physician or other hcp office visit, emergency or emergency medicine, hospital treatment and patient died. He had negative COVID test. The patient underwent lab tests and procedures which included nasal swab: negative on 25Mar2021. The patient died on 28Mar2021.  An autopsy was not performed. Patient received oxygen and antibiotics therapy for events. Outcome of events was fatal.   Events occurred in a country different from that of the reporter.  This may be a duplicate if the reporter also submitted directly to his/her local agency.  The lot number for BNT162B2 was not provided and will be requested during follow up.; Sender's Comments: As there is limited information in the case provided, the causal association between the events and the suspect drug BNT162B2 cannot be excluded. The case will be reassessed once new information is available.  The impact of this report on the benefit-risk profile of the Pfizer product and on the conduct of the study 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 regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Pneumonia; Dyspnoea/shortness of breath; fever; nausea; diarrhea"
	"1853287-1"	"1853287-1"	"PNEUMONIA"	"10035664"	"65-79 years"	"65-79"	"diarrhea; nausea; fever; Dyspnoea/shortness of breath; pneumonia; This is a spontaneous report from a contactable other health professional (patient's child). A 74-year-old male patient received bnt162b2 (COMIRNATY), dose 1 intramuscular, administered in arm left on 08Mar2021 12:00 (Lot Number: unknown) as single dose for covid-19 immunisation at the age of 74-year-old. Medical history included colitis. There was no other vaccine in four weeks. Patient had no known allergies and no covid prior vaccination. Concomitant medications included azathioprine sodium (IMURAN) from an unspecified date and ongoing taken for colitis ulcerosa and steroid etc. The patient experienced diarrhea, nausea, fever, dyspnoea/shortness of breath and pneumonia on 10Mar2021 at 01:00 AM. The patient was hospitalized for events for 4 days.  Events resulted in physician or other hcp office visit, emergency or emergency medicine, hospital treatment and patient died. He had negative COVID test. The patient underwent lab tests and procedures which included nasal swab: negative on 25Mar2021. The patient died on 28Mar2021.  An autopsy was not performed. Patient received oxygen and antibiotics therapy for events. Outcome of events was fatal.   Events occurred in a country different from that of the reporter.  This may be a duplicate if the reporter also submitted directly to his/her local agency.  The lot number for BNT162B2 was not provided and will be requested during follow up.; Sender's Comments: As there is limited information in the case provided, the causal association between the events and the suspect drug BNT162B2 cannot be excluded. The case will be reassessed once new information is available.  The impact of this report on the benefit-risk profile of the Pfizer product and on the conduct of the study 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 regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Pneumonia; Dyspnoea/shortness of breath; fever; nausea; diarrhea"
	"1853287-1"	"1853287-1"	"PYREXIA"	"10037660"	"65-79 years"	"65-79"	"diarrhea; nausea; fever; Dyspnoea/shortness of breath; pneumonia; This is a spontaneous report from a contactable other health professional (patient's child). A 74-year-old male patient received bnt162b2 (COMIRNATY), dose 1 intramuscular, administered in arm left on 08Mar2021 12:00 (Lot Number: unknown) as single dose for covid-19 immunisation at the age of 74-year-old. Medical history included colitis. There was no other vaccine in four weeks. Patient had no known allergies and no covid prior vaccination. Concomitant medications included azathioprine sodium (IMURAN) from an unspecified date and ongoing taken for colitis ulcerosa and steroid etc. The patient experienced diarrhea, nausea, fever, dyspnoea/shortness of breath and pneumonia on 10Mar2021 at 01:00 AM. The patient was hospitalized for events for 4 days.  Events resulted in physician or other hcp office visit, emergency or emergency medicine, hospital treatment and patient died. He had negative COVID test. The patient underwent lab tests and procedures which included nasal swab: negative on 25Mar2021. The patient died on 28Mar2021.  An autopsy was not performed. Patient received oxygen and antibiotics therapy for events. Outcome of events was fatal.   Events occurred in a country different from that of the reporter.  This may be a duplicate if the reporter also submitted directly to his/her local agency.  The lot number for BNT162B2 was not provided and will be requested during follow up.; Sender's Comments: As there is limited information in the case provided, the causal association between the events and the suspect drug BNT162B2 cannot be excluded. The case will be reassessed once new information is available.  The impact of this report on the benefit-risk profile of the Pfizer product and on the conduct of the study 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 regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Pneumonia; Dyspnoea/shortness of breath; fever; nausea; diarrhea"
	"1853287-1"	"1853287-1"	"SARS-COV-2 TEST NEGATIVE"	"10084273"	"65-79 years"	"65-79"	"diarrhea; nausea; fever; Dyspnoea/shortness of breath; pneumonia; This is a spontaneous report from a contactable other health professional (patient's child). A 74-year-old male patient received bnt162b2 (COMIRNATY), dose 1 intramuscular, administered in arm left on 08Mar2021 12:00 (Lot Number: unknown) as single dose for covid-19 immunisation at the age of 74-year-old. Medical history included colitis. There was no other vaccine in four weeks. Patient had no known allergies and no covid prior vaccination. Concomitant medications included azathioprine sodium (IMURAN) from an unspecified date and ongoing taken for colitis ulcerosa and steroid etc. The patient experienced diarrhea, nausea, fever, dyspnoea/shortness of breath and pneumonia on 10Mar2021 at 01:00 AM. The patient was hospitalized for events for 4 days.  Events resulted in physician or other hcp office visit, emergency or emergency medicine, hospital treatment and patient died. He had negative COVID test. The patient underwent lab tests and procedures which included nasal swab: negative on 25Mar2021. The patient died on 28Mar2021.  An autopsy was not performed. Patient received oxygen and antibiotics therapy for events. Outcome of events was fatal.   Events occurred in a country different from that of the reporter.  This may be a duplicate if the reporter also submitted directly to his/her local agency.  The lot number for BNT162B2 was not provided and will be requested during follow up.; Sender's Comments: As there is limited information in the case provided, the causal association between the events and the suspect drug BNT162B2 cannot be excluded. The case will be reassessed once new information is available.  The impact of this report on the benefit-risk profile of the Pfizer product and on the conduct of the study 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 regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Pneumonia; Dyspnoea/shortness of breath; fever; nausea; diarrhea"
	"1865959-1"	"1865959-1"	"SUDDEN DEATH"	"10042434"	"65-79 years"	"65-79"	"sudden death"
	"1869633-1"	"1869633-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death- unexplained"
	"1877338-1"	"1877338-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"Hospitalized with shortness of breath, oxygen saturation less than 80%, BP 220/123 on admission. Trialed BiPap but failed and was intubated. Extubated 11/9."
	"1877338-1"	"1877338-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"Hospitalized with shortness of breath, oxygen saturation less than 80%, BP 220/123 on admission. Trialed BiPap but failed and was intubated. Extubated 11/9."
	"1877338-1"	"1877338-1"	"ENDOTRACHEAL INTUBATION"	"10067450"	"65-79 years"	"65-79"	"Hospitalized with shortness of breath, oxygen saturation less than 80%, BP 220/123 on admission. Trialed BiPap but failed and was intubated. Extubated 11/9."
	"1877338-1"	"1877338-1"	"LUNG INFILTRATION"	"10025102"	"65-79 years"	"65-79"	"Hospitalized with shortness of breath, oxygen saturation less than 80%, BP 220/123 on admission. Trialed BiPap but failed and was intubated. Extubated 11/9."
	"1877338-1"	"1877338-1"	"POSITIVE AIRWAY PRESSURE THERAPY"	"10086397"	"65-79 years"	"65-79"	"Hospitalized with shortness of breath, oxygen saturation less than 80%, BP 220/123 on admission. Trialed BiPap but failed and was intubated. Extubated 11/9."
	"1877338-1"	"1877338-1"	"PULMONARY OEDEMA"	"10037423"	"65-79 years"	"65-79"	"Hospitalized with shortness of breath, oxygen saturation less than 80%, BP 220/123 on admission. Trialed BiPap but failed and was intubated. Extubated 11/9."
	"1879843-1"	"1879843-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Death; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 010A21A) for COVID-19 vaccination.     No Medical History information was reported.    On 12-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on 14-Mar-2021 The patient died on 14-Mar-2021. The cause of death was not reported. It is unknown if an autopsy was performed.            No treatment information was provided.  Patient did not show symptoms before dying. Reporter did not give precise information on HCP and vaccination site and did not know which concomitant medication patient was taking.  Company comment: This fatal spontaneous case concerns a 72-year-old male patient with no relevant medical history who experienced serious unexpected event of death The event occurred 3 days after the second dose of mRNA-1273 vaccine.  Rechallenge is not applicable  The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report; Sender's Comments: This fatal spontaneous case concerns a 72-year-old male patient with no relevant medical history who experienced serious unexpected event of death The event occurred 3 days after the second dose of mRNA-1273 vaccine.  Rechallenge is not applicable  The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report; Reported Cause(s) of Death: Unknown cause of death"
	"1880450-1"	"1880450-1"	"AGEUSIA"	"10001480"	"65-79 years"	"65-79"	"PATIENT ADMITTED TO HOSPITAL 9/30/21 WITH PROGRESSIVE SOB, COUGH, POOR APPETITE, BODY ACHES, LOSS OF TASTE. DIAGNOSED WITH CVODI19 DURING ADMISSION. ISSUES WITH MAINTIANING BP AND OXYGENATION DURING HOSPITALIZATION. CODE BLUE CALLED 10/10/2021, ACLS INITITATED, NO ROSC AFTER 18 MINUTES, FAMILY ASKED TO STOP RESUSCITATION EFFORTS. DIED 10/10/2021 AT HOSPITAL."
	"1880450-1"	"1880450-1"	"BLOOD PRESSURE ABNORMAL"	"10005728"	"65-79 years"	"65-79"	"PATIENT ADMITTED TO HOSPITAL 9/30/21 WITH PROGRESSIVE SOB, COUGH, POOR APPETITE, BODY ACHES, LOSS OF TASTE. DIAGNOSED WITH CVODI19 DURING ADMISSION. ISSUES WITH MAINTIANING BP AND OXYGENATION DURING HOSPITALIZATION. CODE BLUE CALLED 10/10/2021, ACLS INITITATED, NO ROSC AFTER 18 MINUTES, FAMILY ASKED TO STOP RESUSCITATION EFFORTS. DIED 10/10/2021 AT HOSPITAL."
	"1880450-1"	"1880450-1"	"CARDIO-RESPIRATORY ARREST"	"10007617"	"65-79 years"	"65-79"	"PATIENT ADMITTED TO HOSPITAL 9/30/21 WITH PROGRESSIVE SOB, COUGH, POOR APPETITE, BODY ACHES, LOSS OF TASTE. DIAGNOSED WITH CVODI19 DURING ADMISSION. ISSUES WITH MAINTIANING BP AND OXYGENATION DURING HOSPITALIZATION. CODE BLUE CALLED 10/10/2021, ACLS INITITATED, NO ROSC AFTER 18 MINUTES, FAMILY ASKED TO STOP RESUSCITATION EFFORTS. DIED 10/10/2021 AT HOSPITAL."
	"1880450-1"	"1880450-1"	"CHEST X-RAY ABNORMAL"	"10008499"	"65-79 years"	"65-79"	"PATIENT ADMITTED TO HOSPITAL 9/30/21 WITH PROGRESSIVE SOB, COUGH, POOR APPETITE, BODY ACHES, LOSS OF TASTE. DIAGNOSED WITH CVODI19 DURING ADMISSION. ISSUES WITH MAINTIANING BP AND OXYGENATION DURING HOSPITALIZATION. CODE BLUE CALLED 10/10/2021, ACLS INITITATED, NO ROSC AFTER 18 MINUTES, FAMILY ASKED TO STOP RESUSCITATION EFFORTS. DIED 10/10/2021 AT HOSPITAL."
	"1880450-1"	"1880450-1"	"COUGH"	"10011224"	"65-79 years"	"65-79"	"PATIENT ADMITTED TO HOSPITAL 9/30/21 WITH PROGRESSIVE SOB, COUGH, POOR APPETITE, BODY ACHES, LOSS OF TASTE. DIAGNOSED WITH CVODI19 DURING ADMISSION. ISSUES WITH MAINTIANING BP AND OXYGENATION DURING HOSPITALIZATION. CODE BLUE CALLED 10/10/2021, ACLS INITITATED, NO ROSC AFTER 18 MINUTES, FAMILY ASKED TO STOP RESUSCITATION EFFORTS. DIED 10/10/2021 AT HOSPITAL."
	"1880450-1"	"1880450-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"PATIENT ADMITTED TO HOSPITAL 9/30/21 WITH PROGRESSIVE SOB, COUGH, POOR APPETITE, BODY ACHES, LOSS OF TASTE. DIAGNOSED WITH CVODI19 DURING ADMISSION. ISSUES WITH MAINTIANING BP AND OXYGENATION DURING HOSPITALIZATION. CODE BLUE CALLED 10/10/2021, ACLS INITITATED, NO ROSC AFTER 18 MINUTES, FAMILY ASKED TO STOP RESUSCITATION EFFORTS. DIED 10/10/2021 AT HOSPITAL."
	"1880450-1"	"1880450-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"PATIENT ADMITTED TO HOSPITAL 9/30/21 WITH PROGRESSIVE SOB, COUGH, POOR APPETITE, BODY ACHES, LOSS OF TASTE. DIAGNOSED WITH CVODI19 DURING ADMISSION. ISSUES WITH MAINTIANING BP AND OXYGENATION DURING HOSPITALIZATION. CODE BLUE CALLED 10/10/2021, ACLS INITITATED, NO ROSC AFTER 18 MINUTES, FAMILY ASKED TO STOP RESUSCITATION EFFORTS. DIED 10/10/2021 AT HOSPITAL."
	"1880450-1"	"1880450-1"	"DECREASED APPETITE"	"10061428"	"65-79 years"	"65-79"	"PATIENT ADMITTED TO HOSPITAL 9/30/21 WITH PROGRESSIVE SOB, COUGH, POOR APPETITE, BODY ACHES, LOSS OF TASTE. DIAGNOSED WITH CVODI19 DURING ADMISSION. ISSUES WITH MAINTIANING BP AND OXYGENATION DURING HOSPITALIZATION. CODE BLUE CALLED 10/10/2021, ACLS INITITATED, NO ROSC AFTER 18 MINUTES, FAMILY ASKED TO STOP RESUSCITATION EFFORTS. DIED 10/10/2021 AT HOSPITAL."
	"1880450-1"	"1880450-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"PATIENT ADMITTED TO HOSPITAL 9/30/21 WITH PROGRESSIVE SOB, COUGH, POOR APPETITE, BODY ACHES, LOSS OF TASTE. DIAGNOSED WITH CVODI19 DURING ADMISSION. ISSUES WITH MAINTIANING BP AND OXYGENATION DURING HOSPITALIZATION. CODE BLUE CALLED 10/10/2021, ACLS INITITATED, NO ROSC AFTER 18 MINUTES, FAMILY ASKED TO STOP RESUSCITATION EFFORTS. DIED 10/10/2021 AT HOSPITAL."
	"1880450-1"	"1880450-1"	"OXYGEN SATURATION ABNORMAL"	"10033317"	"65-79 years"	"65-79"	"PATIENT ADMITTED TO HOSPITAL 9/30/21 WITH PROGRESSIVE SOB, COUGH, POOR APPETITE, BODY ACHES, LOSS OF TASTE. DIAGNOSED WITH CVODI19 DURING ADMISSION. ISSUES WITH MAINTIANING BP AND OXYGENATION DURING HOSPITALIZATION. CODE BLUE CALLED 10/10/2021, ACLS INITITATED, NO ROSC AFTER 18 MINUTES, FAMILY ASKED TO STOP RESUSCITATION EFFORTS. DIED 10/10/2021 AT HOSPITAL."
	"1880450-1"	"1880450-1"	"PAIN"	"10033371"	"65-79 years"	"65-79"	"PATIENT ADMITTED TO HOSPITAL 9/30/21 WITH PROGRESSIVE SOB, COUGH, POOR APPETITE, BODY ACHES, LOSS OF TASTE. DIAGNOSED WITH CVODI19 DURING ADMISSION. ISSUES WITH MAINTIANING BP AND OXYGENATION DURING HOSPITALIZATION. CODE BLUE CALLED 10/10/2021, ACLS INITITATED, NO ROSC AFTER 18 MINUTES, FAMILY ASKED TO STOP RESUSCITATION EFFORTS. DIED 10/10/2021 AT HOSPITAL."
	"1880450-1"	"1880450-1"	"PNEUMONIA"	"10035664"	"65-79 years"	"65-79"	"PATIENT ADMITTED TO HOSPITAL 9/30/21 WITH PROGRESSIVE SOB, COUGH, POOR APPETITE, BODY ACHES, LOSS OF TASTE. DIAGNOSED WITH CVODI19 DURING ADMISSION. ISSUES WITH MAINTIANING BP AND OXYGENATION DURING HOSPITALIZATION. CODE BLUE CALLED 10/10/2021, ACLS INITITATED, NO ROSC AFTER 18 MINUTES, FAMILY ASKED TO STOP RESUSCITATION EFFORTS. DIED 10/10/2021 AT HOSPITAL."
	"1880450-1"	"1880450-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"PATIENT ADMITTED TO HOSPITAL 9/30/21 WITH PROGRESSIVE SOB, COUGH, POOR APPETITE, BODY ACHES, LOSS OF TASTE. DIAGNOSED WITH CVODI19 DURING ADMISSION. ISSUES WITH MAINTIANING BP AND OXYGENATION DURING HOSPITALIZATION. CODE BLUE CALLED 10/10/2021, ACLS INITITATED, NO ROSC AFTER 18 MINUTES, FAMILY ASKED TO STOP RESUSCITATION EFFORTS. DIED 10/10/2021 AT HOSPITAL."
	"1889704-1"	"1889704-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient expired."
	"1889749-1"	"1889749-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient expired."
	"1893815-1"	"1893815-1"	"ABDOMINAL PAIN UPPER"	"10000087"	"65-79 years"	"65-79"	"Pain in back and high stomach area for 2 weeks.  Ultimately resulted in aorta pulling away from stomach and causing repaired aneurysm to rupture."
	"1893815-1"	"1893815-1"	"AORTIC ANEURYSM RUPTURE"	"10002886"	"65-79 years"	"65-79"	"Pain in back and high stomach area for 2 weeks.  Ultimately resulted in aorta pulling away from stomach and causing repaired aneurysm to rupture."
	"1893815-1"	"1893815-1"	"BACK PAIN"	"10003988"	"65-79 years"	"65-79"	"Pain in back and high stomach area for 2 weeks.  Ultimately resulted in aorta pulling away from stomach and causing repaired aneurysm to rupture."
	"1893815-1"	"1893815-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Pain in back and high stomach area for 2 weeks.  Ultimately resulted in aorta pulling away from stomach and causing repaired aneurysm to rupture."
	"1893815-1"	"1893815-1"	"RESUSCITATION"	"10038749"	"65-79 years"	"65-79"	"Pain in back and high stomach area for 2 weeks.  Ultimately resulted in aorta pulling away from stomach and causing repaired aneurysm to rupture."
	"1905782-1"	"1905782-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"Patient is now deceased, very likely from Covid-19, based on the positive test of her spouse, and very similar symptoms"
	"1905782-1"	"1905782-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"Patient is now deceased, very likely from Covid-19, based on the positive test of her spouse, and very similar symptoms"
	"1905782-1"	"1905782-1"	"EXPOSURE TO SARS-COV-2"	"10084456"	"65-79 years"	"65-79"	"Patient is now deceased, very likely from Covid-19, based on the positive test of her spouse, and very similar symptoms"
	"1913858-1"	"1913858-1"	"CONDITION AGGRAVATED"	"10010264"	"65-79 years"	"65-79"	"This is an instance of breakthrough case of COVID-19 that resulted in death.   The individual was vaccinated with the Moderna product on 12/30/2020 and 01/27/2021.   The individual became symptomatic on 04/17/2021 and tested positive for COVID-19 on 04/17/2021.   The individual was hospitalized 05/01/2021-05/04/2021 with a chief complaint of altered mental status; they were found to be septic and have a UTI and also to have developed pneumonia.  The individual responded well to antibiotics, and was therefore discharged to the long-term care facility at which they were a resident. The individual  continued to be monitored for prolonged shortness of breath,  and ultimately passed away on 05/10/2021.   Death Certificate details are as follows:  Part I Cause of Death    A: Pneumonia    B: COPD Part II Other Significant Conditions    COVID 19, Diabetes Mellitus, Schizophrenia"
	"1913858-1"	"1913858-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"This is an instance of breakthrough case of COVID-19 that resulted in death.   The individual was vaccinated with the Moderna product on 12/30/2020 and 01/27/2021.   The individual became symptomatic on 04/17/2021 and tested positive for COVID-19 on 04/17/2021.   The individual was hospitalized 05/01/2021-05/04/2021 with a chief complaint of altered mental status; they were found to be septic and have a UTI and also to have developed pneumonia.  The individual responded well to antibiotics, and was therefore discharged to the long-term care facility at which they were a resident. The individual  continued to be monitored for prolonged shortness of breath,  and ultimately passed away on 05/10/2021.   Death Certificate details are as follows:  Part I Cause of Death    A: Pneumonia    B: COPD Part II Other Significant Conditions    COVID 19, Diabetes Mellitus, Schizophrenia"
	"1913858-1"	"1913858-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"This is an instance of breakthrough case of COVID-19 that resulted in death.   The individual was vaccinated with the Moderna product on 12/30/2020 and 01/27/2021.   The individual became symptomatic on 04/17/2021 and tested positive for COVID-19 on 04/17/2021.   The individual was hospitalized 05/01/2021-05/04/2021 with a chief complaint of altered mental status; they were found to be septic and have a UTI and also to have developed pneumonia.  The individual responded well to antibiotics, and was therefore discharged to the long-term care facility at which they were a resident. The individual  continued to be monitored for prolonged shortness of breath,  and ultimately passed away on 05/10/2021.   Death Certificate details are as follows:  Part I Cause of Death    A: Pneumonia    B: COPD Part II Other Significant Conditions    COVID 19, Diabetes Mellitus, Schizophrenia"
	"1913858-1"	"1913858-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"This is an instance of breakthrough case of COVID-19 that resulted in death.   The individual was vaccinated with the Moderna product on 12/30/2020 and 01/27/2021.   The individual became symptomatic on 04/17/2021 and tested positive for COVID-19 on 04/17/2021.   The individual was hospitalized 05/01/2021-05/04/2021 with a chief complaint of altered mental status; they were found to be septic and have a UTI and also to have developed pneumonia.  The individual responded well to antibiotics, and was therefore discharged to the long-term care facility at which they were a resident. The individual  continued to be monitored for prolonged shortness of breath,  and ultimately passed away on 05/10/2021.   Death Certificate details are as follows:  Part I Cause of Death    A: Pneumonia    B: COPD Part II Other Significant Conditions    COVID 19, Diabetes Mellitus, Schizophrenia"
	"1913858-1"	"1913858-1"	"MENTAL STATUS CHANGES"	"10048294"	"65-79 years"	"65-79"	"This is an instance of breakthrough case of COVID-19 that resulted in death.   The individual was vaccinated with the Moderna product on 12/30/2020 and 01/27/2021.   The individual became symptomatic on 04/17/2021 and tested positive for COVID-19 on 04/17/2021.   The individual was hospitalized 05/01/2021-05/04/2021 with a chief complaint of altered mental status; they were found to be septic and have a UTI and also to have developed pneumonia.  The individual responded well to antibiotics, and was therefore discharged to the long-term care facility at which they were a resident. The individual  continued to be monitored for prolonged shortness of breath,  and ultimately passed away on 05/10/2021.   Death Certificate details are as follows:  Part I Cause of Death    A: Pneumonia    B: COPD Part II Other Significant Conditions    COVID 19, Diabetes Mellitus, Schizophrenia"
	"1913858-1"	"1913858-1"	"PNEUMONIA"	"10035664"	"65-79 years"	"65-79"	"This is an instance of breakthrough case of COVID-19 that resulted in death.   The individual was vaccinated with the Moderna product on 12/30/2020 and 01/27/2021.   The individual became symptomatic on 04/17/2021 and tested positive for COVID-19 on 04/17/2021.   The individual was hospitalized 05/01/2021-05/04/2021 with a chief complaint of altered mental status; they were found to be septic and have a UTI and also to have developed pneumonia.  The individual responded well to antibiotics, and was therefore discharged to the long-term care facility at which they were a resident. The individual  continued to be monitored for prolonged shortness of breath,  and ultimately passed away on 05/10/2021.   Death Certificate details are as follows:  Part I Cause of Death    A: Pneumonia    B: COPD Part II Other Significant Conditions    COVID 19, Diabetes Mellitus, Schizophrenia"
	"1913858-1"	"1913858-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"This is an instance of breakthrough case of COVID-19 that resulted in death.   The individual was vaccinated with the Moderna product on 12/30/2020 and 01/27/2021.   The individual became symptomatic on 04/17/2021 and tested positive for COVID-19 on 04/17/2021.   The individual was hospitalized 05/01/2021-05/04/2021 with a chief complaint of altered mental status; they were found to be septic and have a UTI and also to have developed pneumonia.  The individual responded well to antibiotics, and was therefore discharged to the long-term care facility at which they were a resident. The individual  continued to be monitored for prolonged shortness of breath,  and ultimately passed away on 05/10/2021.   Death Certificate details are as follows:  Part I Cause of Death    A: Pneumonia    B: COPD Part II Other Significant Conditions    COVID 19, Diabetes Mellitus, Schizophrenia"
	"1913858-1"	"1913858-1"	"SEPSIS"	"10040047"	"65-79 years"	"65-79"	"This is an instance of breakthrough case of COVID-19 that resulted in death.   The individual was vaccinated with the Moderna product on 12/30/2020 and 01/27/2021.   The individual became symptomatic on 04/17/2021 and tested positive for COVID-19 on 04/17/2021.   The individual was hospitalized 05/01/2021-05/04/2021 with a chief complaint of altered mental status; they were found to be septic and have a UTI and also to have developed pneumonia.  The individual responded well to antibiotics, and was therefore discharged to the long-term care facility at which they were a resident. The individual  continued to be monitored for prolonged shortness of breath,  and ultimately passed away on 05/10/2021.   Death Certificate details are as follows:  Part I Cause of Death    A: Pneumonia    B: COPD Part II Other Significant Conditions    COVID 19, Diabetes Mellitus, Schizophrenia"
	"1913858-1"	"1913858-1"	"URINARY TRACT INFECTION"	"10046571"	"65-79 years"	"65-79"	"This is an instance of breakthrough case of COVID-19 that resulted in death.   The individual was vaccinated with the Moderna product on 12/30/2020 and 01/27/2021.   The individual became symptomatic on 04/17/2021 and tested positive for COVID-19 on 04/17/2021.   The individual was hospitalized 05/01/2021-05/04/2021 with a chief complaint of altered mental status; they were found to be septic and have a UTI and also to have developed pneumonia.  The individual responded well to antibiotics, and was therefore discharged to the long-term care facility at which they were a resident. The individual  continued to be monitored for prolonged shortness of breath,  and ultimately passed away on 05/10/2021.   Death Certificate details are as follows:  Part I Cause of Death    A: Pneumonia    B: COPD Part II Other Significant Conditions    COVID 19, Diabetes Mellitus, Schizophrenia"
	"1913858-1"	"1913858-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"This is an instance of breakthrough case of COVID-19 that resulted in death.   The individual was vaccinated with the Moderna product on 12/30/2020 and 01/27/2021.   The individual became symptomatic on 04/17/2021 and tested positive for COVID-19 on 04/17/2021.   The individual was hospitalized 05/01/2021-05/04/2021 with a chief complaint of altered mental status; they were found to be septic and have a UTI and also to have developed pneumonia.  The individual responded well to antibiotics, and was therefore discharged to the long-term care facility at which they were a resident. The individual  continued to be monitored for prolonged shortness of breath,  and ultimately passed away on 05/10/2021.   Death Certificate details are as follows:  Part I Cause of Death    A: Pneumonia    B: COPD Part II Other Significant Conditions    COVID 19, Diabetes Mellitus, Schizophrenia"
	"1917294-1"	"1917294-1"	"COVID-19"	"10084268"	"65-79 years"	"65-79"	"This is an instance of breakthrough COVID-19 disease after which a death occurred.  The individual was vaccinated with the Pfizer product on 02/10/2021 and 03/03/2021.  The individual became symptomatic with progressively worsening shortness of breath on 04/19/2021 and sought COVID-19 testing on  04/22/2021, which was positive via PCR.  The individual then visited the emergency department on 04/22/2021 and was admitted to hospital same day. They then remained hospitalized until their death on 05/11/2021.   Death Certificate details are as follows:  Part I Cause of Death   A: COVID 19 Part II Other Significant Conditions:    History of Liver Failure"
	"1917294-1"	"1917294-1"	"DEATH"	"10011906"	"65-79 years"	"65-79"	"This is an instance of breakthrough COVID-19 disease after which a death occurred.  The individual was vaccinated with the Pfizer product on 02/10/2021 and 03/03/2021.  The individual became symptomatic with progressively worsening shortness of breath on 04/19/2021 and sought COVID-19 testing on  04/22/2021, which was positive via PCR.  The individual then visited the emergency department on 04/22/2021 and was admitted to hospital same day. They then remained hospitalized until their death on 05/11/2021.   Death Certificate details are as follows:  Part I Cause of Death   A: COVID 19 Part II Other Significant Conditions:    History of Liver Failure"
	"1917294-1"	"1917294-1"	"DYSPNOEA"	"10013968"	"65-79 years"	"65-79"	"This is an instance of breakthrough COVID-19 disease after which a death occurred.  The individual was vaccinated with the Pfizer product on 02/10/2021 and 03/03/2021.  The individual became symptomatic with progressively worsening shortness of breath on 04/19/2021 and sought COVID-19 testing on  04/22/2021, which was positive via PCR.  The individual then visited the emergency department on 04/22/2021 and was admitted to hospital same day. They then remained hospitalized until their death on 05/11/2021.   Death Certificate details are as follows:  Part I Cause of Death   A: COVID 19 Part II Other Significant Conditions:    History of Liver Failure"
	"1917294-1"	"1917294-1"	"MALAISE"	"10025482"	"65-79 years"	"65-79"	"This is an instance of breakthrough COVID-19 disease after which a death occurred.  The individual was vaccinated with the Pfizer product on 02/10/2021 and 03/03/2021.  The individual became symptomatic with progressively worsening shortness of breath on 04/19/2021 and sought COVID-19 testing on  04/22/2021, which was positive via PCR.  The individual then visited the emergency department on 04/22/2021 and was admitted to hospital same day. They then remained hospitalized until their death on 05/11/2021.   Death Certificate details are as follows:  Part I Cause of Death   A: COVID 19 Part II Other Significant Conditions:    History of Liver Failure"
	"1917294-1"	"1917294-1"	"SARS-COV-2 TEST POSITIVE"	"10084271"	"65-79 years"	"65-79"	"This is an instance of breakthrough COVID-19 disease after which a death occurred.  The individual was vaccinated with the Pfizer product on 02/10/2021 and 03/03/2021.  The individual became symptomatic with progressively worsening shortness of breath on 04/19/2021 and sought COVID-19 testing on  04/22/2021, which was positive via PCR.  The individual then visited the emergency department on 04/22/2021 and was admitted to hospital same day. They then remained hospitalized until their death on 05/11/2021.   Death Certificate details are as follows:  Part I Cause of Death   A: COVID 19 Part II Other Significant Conditions:    History of Liver Failure"
	"1917294-1"	"1917294-1"	"VACCINE BREAKTHROUGH INFECTION"	"10067923"	"65-79 years"	"65-79"	"This is an instance of breakthrough COVID-19 disease after which a death occurred.  The individual was vaccinated with the Pfizer product on 02/10/2021 and 03/03/2021.  The individual became symptomatic with progressively worsening shortness of breath on 04/19/2021 and sought COVID-19 testing on  04/22/2021, which was positive via PCR.  The individual then visited the emergency department on 04/22/2021 and was admitted to hospital same day. They then remained hospitalized until their death on 05/11/2021.   Death Certificate details are as follows:  Part I Cause of Death   A: COVID 19 Part II Other Significant Conditions:    History of Liver Failure"
"---"
"Dataset: The Vaccine Adverse Event Reporting System (VAERS)"
"Query Parameters:"
"Title: 211214 CDC covid VAERS report - all reports"
"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: Oregon; Pennsylvania; Rhode Island; South Carolina; South Dakota; Tennessee"
"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 4:31:03 PM"
"---"
"Suggested Citation: Accessed at http://wonder.cdc.gov/vaers.html on Dec 14, 2021 4:31:03 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 257 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>"